Penetrating chest wall injury with left ventricular damage, evolution and prognosis, clinical case

Abstract

Background. Penetrating cardiac trauma of the left ventricle (LV) is a rare and serious injury. The outcome of a penetrating wound in the chest can range from immediate death to prolonged morbidity, complicated with cardiac tamponade, needing a prompt control of cardiac hemorrhage, and pericardial decompression. Objective(s). Presentation of the clinical case of a socio-vulnerable patient, avid drinker, who presented himself at IMSP SCM „Holy Trinity” after being stabbed in the rib cage, in critical state. Materials and methods. Patient M., man, 52 years old, without cardiovascular risk factors, admitted to IMSP SCM 'Holy Trinity' with a penetrating wound of the chest cavity, was diagnosed through investigations including electrocardiogram, echocardiography, chest radiography, hemoleucogram, biochemical analyses, and underwent emergency surgery. Results. After surgery: HR 95 bpm, BP 130/75 mmHg. ECG: sinus rhythm with HR 100 bpm, ST depression in the inferior region. Laboratory Results. TnI - 7.5 mg/l, Hb - 87 g/l, leukocytosis - 21.7 mln, pH - 6.9, lactate - 6.5. Chest radiography: free fluid on the left. USG of internal organs: no particularities. EchoCG: hypokinesia of the inferior wall and apex, slightly reduced EF - 43%, moderate pericardial fluid with signs of cardiac tamponade (hemopericardium). After 15 days, the general condition improved. On radiography bilateral pleural resorption. Dynamic EchoCG: EF increased to 55%, hypokinesia of the inferior wall, minimal pericardial fluid. Conclusion(s). Cardiac trauma and penetrating injuries are usually fatal unless diagnosed promptly and treated surgically. The postoperative management of these patients plays a major role in recovery and prevention of heart failure and its complications. Echocardiography is the golden standard in diagnosis.