The pattern of penetrating cardiac trauma in Basrah Province: personal experience with seventy-two cases in a hospital without cardiopulmonary by-pass facility.

A total of 72 patients with penetrating cardiac injuries were treated at Teaching Hospital in Basrah from February 1984 to July 1988. All patients were males, ages ranged between 18-40 years. 67 patients (93%) had sustained shell fragment injuries and 5 patients (6.9%) bullet wounds. 13 patients were unconscious on arrival and had no detectable pulse or cardiac activity and no obtainable blood pressure. Emergency room thoracotomy was employed in these patients. It restored cardiac activity in only one patient. 42 patients (58.3%) arrived with hypotension. 52 patients had one or more signs of heart tamponade (72.2%). The clinical triad of low blood pressure, central venous hypertension and distant heart sounds proved diagnostic in 73% of patients with heart injuries having tamponade. Pulsus paradoxus was found in 4% of the patients. Pericardiocentesis was of little value in diagnosis and treatment of cardiac tamponade and was not performed. The right ventricle was the most commonly injured chamber (44.4%). 56 patients (77.8%) presented with a normal sinus rhythm and 3 patients (4%) had an idioventricular rhythm. Patients with disorganised cardiac rhythm had a higher mortality (87%), than those with normal sinus rhythm (15%).