Ngwisanyi Weludo, Moeng Shirley F A P, Moeng Maeyane
Department of Surgery, University of the Witwatersrand, South Africa.
Int J Surg Case Rep. 2021 Mar;80:105673. doi: 10.1016/j.ijscr.2021.105673. Epub 2021 Feb 22.
Cardiac injuries are associated with high mortality rates and most affected individuals succumb to their injuries before arrival to the hospital. Even though they have a higher fatality rate, penetrating cardiac injuries are relatively easy to diagnose and they have straightforward management protocols. On the other hand unexpected non-penetrating cardiac injuries, especially in haemodynamically stable patients, are not looked out for and can be difficult to diagnose. They may have a delayed presentation leading to poor patient outcomes. Clinicians should have a high index of suspicion when wound paths are in the vicinity of the heart, to avoid missing early signs and possibly prevent late presentation of these injuries.
Two previously well male patients aged 29 and 33 years old respectively, sustained gunshot wounds to the thoracoabdomen which in each case became associated with non perforating cardiac injuries. The first case highlighted the unfortunate end of these uncommon injuries when there are other serious injuries present. The second case illustrated possibility of late complications even after management of non-penetrating cardiac injury.
In these cases, shock wave injury refers to non penetrating cardiac injury induced by high a voltage bullet in proximity to the heart/pericardium. A thorough history and examination in addition to multiple investigational modalities should be performed in order to exclude cardiac shockwave injuries. In some instances serial imaging studies are needed to detect the earliest changes associated with these injuries.
Cardiac injuries carry a high morbidity and mortality and therefore a timeous diagnosis and management of these injuries is essential to prevent fatalities.
心脏损伤与高死亡率相关，大多数受影响的个体在抵达医院之前就因伤死亡。尽管穿透性心脏损伤死亡率较高，但相对容易诊断，且有直接的处理方案。另一方面，意外的非穿透性心脏损伤，尤其是在血流动力学稳定的患者中，容易被忽视且难以诊断。它们可能会延迟出现，导致患者预后不良。当伤口路径靠近心脏时，临床医生应高度怀疑，以避免漏诊早期迹象，并可能预防这些损伤的延迟出现。
两名分别为29岁和33岁的既往健康男性患者，胸部和腹部遭受枪伤，均伴有非穿孔性心脏损伤。第一个病例突出了在存在其他严重损伤时这些罕见损伤的不幸结局。第二个病例说明了即使在处理非穿透性心脏损伤后仍可能出现晚期并发症。
在这些病例中，冲击波损伤是指由靠近心脏/心包的高电压子弹引起的非穿透性心脏损伤。除了多种检查方式外，还应进行全面的病史询问和体格检查，以排除心脏冲击波损伤。在某些情况下，需要进行系列影像学检查以检测与这些损伤相关的最早变化。
心脏损伤具有高发病率和死亡率，因此及时诊断和处理这些损伤对于预防死亡至关重要。
