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Cardiac Trauma (Screening investigations prior to anaesthesia (ECG (RV…
Cardiac Trauma
Screening investigations prior to anaesthesia
Troponin
Sensitive indicator of cardiac damage
May have role here prior to taking patient for anaesthetic
May also be elevated in CNS injury
Cheap, rapid
ECG
RV most commonly involved in contusion
Sinus tachy, dysrhythmia, ectopic, BBB or non specific ST segment abnormalities may be seen
Usually changes within the first 24 hrs
Sensitive
Cheap, rapid
CXR
Usual part of trauma workup
Not sensitive or specific for many cardiac injuries, but may show tamponade, haemothorax or associated injuries
May show consequences of cardiac injury e.g. pulmonary oedema
Cheap, rapid
TTE/TOE
Basic TTE forms part of FAST scan (adequate studies not possible in ~ 30% of patients)
TOE better than TTE for views of walls, septum, valves and pericardial fluid
If concern consider TOE based on above tests and risk of structural cardiac injuries and cardiac function
Good sensitivity and specificity
Depends upon operator availability, more invasive
CT angiogram
Anatomic information, arterial/venous bleeding dx
100% sensitivity, specificity ~ 80%
Only in stabilised patient
More expensive
Injuries to heart with blunt trauma
Acute
Cardiac contusion
Cardiac laceration
Tamponade
Cardiac wall rupture, septal defect
Pericardial rupture
Coronary injury leading to ischaemia
Valvular injury with acute incompetence
Chronic
Shunt
Fistulae
Pericarditis
Coronary artery thrombosis