Echocardiography in cardiac trauma

Overview

Cardiac injury as a result of blunt or penetrating chest trauma is common and associated with significant morbidity and mortality. Approximately 25% of traumatic deaths are caused by cardiac-related injuries, with the majority involving either cardiac or great-vessel damage. Most penetrating cardiac wounds are immediately fatal. For those arriving at the hospital alive, focused assessment with sonography for trauma (FAST) and transthoracic echocardiography (TTE) are the primary screening modalities. These injuries remain a challenge to trauma surgeons and are associated with high mortality. The incidence of blunt cardiac injury is unknown because of the lack of an accepted “gold standard” test for diagnosis. Blunt cardiac trauma can cause a wide spectrum of injuries (e.g., conduction abnormalities, valvular injuries, septum or free wall rupture, and coronary artery thrombosis).

Patients with cardiac injury may have profound hypotension necessitating urgent surgery; however, a significant number of patients arrive at the emergency department without overt symptoms of heart injury. Regardless of the cause or the clinical picture, diagnosis should be made rapidly. If these patients are exposed to delays in diagnosis or treatment, deaths may occur that would otherwise have been classified as preventable .

The initial evaluation of patients who sustain cardiac trauma includes physical examination and chest radiography. The sensitivity and specificity of both modalities for diagnosing cardiac injury are low, however. Other diagnostic tools include subxiphoid exploration (SXE), two-dimensional TTE, transesophageal echocardiography (TEE), and FAST.

Diagnostic methods