Michels G, Hoppe U C
Klinik III für Innere Medizin der Universität zu Köln, Cologne.
Dtsch Med Wochenschr. 2004 Jun 18;129(25-26):1427-9. doi: 10.1055/s-2004-826884.
A 35-year-old patient presented with a non-penetrating chest trauma due to an automobile accident. Examinations showed a trauma of the left shoulder (reversed Hill-Sachs lesion). After diagnostic procedures, he underwent surgery four weeks later. During the hospital stay, the patient developed angina pectoris, dizziness and syncopes.
When the patient was transferred to our institution a 12-leads electrocardiogram and blood analysis were unremarkable. Cardiac catheterization revealed a relaxation disorder of the left ventricular anterior wall with normal coronaries. The Holter-ECG detected with occasional attacks of dizziness and recurrent syncopes concurrent with intermittent episodes of high-degree atrioventricular block and supraventricular tachycardias. This led to the diagnosis of myocardial contusion with long term symptomatic arrhythmias.
Since syncopes and arrhythmias persisted over several weeks following myocardial contusion a combined therapy with a dual chamber pacemaker and beta-blocker was initiated.
ECG monitoring after blunt chest trauma in the early period and after several days is mandatory to screen and prevent potentially life threatening posttraumatic arrhythmias.
一名35岁患者因汽车事故导致非穿透性胸部创伤。检查发现左肩有创伤（反Hill-Sachs损伤）。经过诊断程序后，他在四周后接受了手术。住院期间，患者出现心绞痛、头晕和晕厥。
患者转至我院时，12导联心电图和血液分析无异常。心脏导管检查显示左心室前壁舒张功能障碍，冠状动脉正常。动态心电图检测到偶尔发作的头晕以及与间歇性高度房室传导阻滞和室上性心动过速同时出现的反复晕厥。这导致诊断为心肌挫伤伴长期有症状性心律失常。
由于心肌挫伤后晕厥和心律失常持续数周，开始采用双腔起搏器和β受体阻滞剂联合治疗。
钝性胸部创伤早期及数天后必须进行心电图监测，以筛查和预防潜在的危及生命的创伤后心律失常。
