• Matthew S. Slater


Seven days after undergoing a thoracotomy and repair of a cardiac laceration, a 22-year-old patient develops tachycardia, substernal chest pain (worse on inspiration) and fatigue. He is afebrile and hemodynamically stable. On auscultation, a pericardial friction rub is discovered. Electrocardiography demonstrates ST segment elevation throughout the pericardium. Helical computed tomography scan shows no evidence of a pulmonary embolism. Chest x-ray reveals expanded bilateral lungs and a normal cardiac silhouette. Which of the following would be the most appropriate management approach?
  1. (A)

    Administration of a nonsteroidal antiinflammatory agent

  2. (B)


  3. (C)


  4. (D)

    Insertion of a pulmonary artery catheter

  5. (E)

    Cardiac catheterization



Cardiac Tamponade Gunshot Wound Cardiac Injury Stab Wound Blunt Chest Trauma 
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  1. 1.
    Campbell N, Thomson S, Muckart J, Meumann C, Middelkoop IV, Botha J. Review of 1198 cases of penetrating cardiac trauma. Br J Surg 1998; 85:1737–1740.CrossRefGoogle Scholar
  2. 2.
    Rhee P, Foy H, Kaufmann C, et al. Penetrating cardiac injuries: a population-based study. J Trauma 1998; 45(2): 366–370.CrossRefPubMedGoogle Scholar
  3. 3.
    Asensio J, Bern J, Demetriades D, et al. One hundred five penetrating cardiac injuries: a 2-year prospective evaluation. J Trauma 1998; 44(6):1073–1082.CrossRefPubMedGoogle Scholar
  4. 4.
    Tyburski J, Astra L, Wilson R, Dente C, Steffes C. Factors affecting prognosis with penetrating wounds of the heart. J Trauma 2000; 48(4):587–591.CrossRefPubMedGoogle Scholar
  5. 5.
    Wall J, Mattox K, Baldwin J. Acute management of complex cardiac injuries. J Trauma 1997; 42:905.CrossRefPubMedGoogle Scholar
  6. 6.
    Duque H, Florez L, Moreno A, Jurado H, Jaramillo C, Restrepo M. Penetrating cardiac trauma: follow-up study including electrocardiography, echocardiography, and functional test.World J Surg 1999; 23:1254–1257.CrossRefPubMedGoogle Scholar
  7. 7.
    Enriquez S, Fernadez C, Entem F, Garagarza J, Duran R. Delayed pericardial tamponade after penetrating chest trauma. Eur J Emerg Med 2005; 12(2):86–88.CrossRefPubMedGoogle Scholar
  8. 8.
    Presenti-Rossi D, Godart F, Dubar A, Rey C.Transcatheter closure of traumatic ventricular septal defect: an alternative to surgery. Chest 2003; 123(6):2144–2145.CrossRefGoogle Scholar
  9. 9.
    Le Blang S, Dolich M. Imaging of penetrating thoracic trauma. J Thorac Imaging 2000; 15(2):128–135.CrossRefGoogle Scholar
  10. 10.
    Rozycki G, Feliciano D, Ochsner M, et al.The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma 1999; 46(4):543–552.CrossRefPubMedGoogle Scholar
  11. 11.
    Morales C, Salinas C, Henao C, Patino P, Munoz C. Thoracoscopic pericardial window and penetrating cardiac trauma. J Trauma 1997; 42(2):273–275.CrossRefPubMedGoogle Scholar
  12. 12.
    Gao J, Gao Y, Wei G, et al. Penetrating cardiac wounds: principles for surgical management. World J Surg 2004; 28:1025–1029.CrossRefPubMedGoogle Scholar
  13. 13.
    Mandal A, Sanusi M. Penetrating chest wounds: 24 years experience. World J Surg 2001; 25(9):1145–1149.PubMedGoogle Scholar
  14. 14.
    Mittal M, McAleese P, Young S, Cohen M. Penetrating cardiac injuries. Am Surgeon 1999; 65:444–448.PubMedGoogle Scholar
  15. 15.
    Lindstaedt M, Germing A, Lawo T, et al. Acute and longterm clinical significance of myocardial contusion following blunt thoracic trauma: results of a prospective study. J Trauma 2001; 52(3):479–485.CrossRefGoogle Scholar
  16. 16.
    Wicky S, Wintermark M, Schnyder P, Capasso P, Denys A. Imaging of blunt chest trauma. Eur Radiol 2000; 10:1524–1528.CrossRefPubMedGoogle Scholar
  17. 17.
    Lancey R, Monahan T. Correlation of clinical characteristics and outcomes with injury scoring in blunt cardiac trauma. J Trauma 2003; 54(3):509–515.CrossRefPubMedGoogle Scholar
  18. 18.
    Turk E, Tsokos M. Blunt cardiac trauma caused by fatal falls from height: an autopsy-based assessment of the injury pattern. J Trauma 2004; 57(2):301–304.CrossRefPubMedGoogle Scholar
  19. 19.
    Perron A, Brady W, Erling B. Commotio cordis: an underappreciated cause of sudden cardiac death in young patients: assessment and management in the ED. Am J Emerg Med 2001; 19(5):406–409.CrossRefPubMedGoogle Scholar
  20. 20.
    Rashid M, Ortenwall P, Wikstrom T. Cardiovascular injuries associated with sternal fractures. Eur J Surg 2001; 167:243–248.CrossRefPubMedGoogle Scholar
  21. 21.
    Ladurner R, Qvick L, Hohenbleicher F, Hallfeldt K, Mutschler W, Mussack T. Pneumopericardium in blunt chest trauma after high-speed motor vehicle accidents. Am J Emerg Med 2005; 23:83–86.CrossRefPubMedGoogle Scholar
  22. 22.
    Braatz T, Mirvis S, Killeen K, Lightman N. CT diagnosis of internal mammary artery injury caused by blunt trauma. Clin Radiol 2001; 56:120–123.CrossRefPubMedGoogle Scholar
  23. 23.
    Salim A, Vemahos G, Jindal A, et al. Clinically significant blunt cardiac trauma: role of serum troponin levels combined with electrocardiographic findings. J Trauma 2001; 50(2):237–243.CrossRefPubMedGoogle Scholar
  24. 24.
    Velmahos G, Karaiskakis M, Salim A, et al. Normal Electrocardiography and serum troponin I levels preclude the presence of clinically significant blunt cardiac injury. J Trauma 2003; 54(1):45–51.CrossRefPubMedGoogle Scholar
  25. 25.
    Rajan G, Zellweger R. Cardiac troponin I as a predictor of arrhythmia and ventricular dysfunction in trauma patients with myocardial contusion. J Trauma 2004; 57(4):801–808.CrossRefPubMedGoogle Scholar
  26. 26.
    Naseer N, Aronow W, McClung J, et al. Circumflex coronary artery occlusion after blunt chest trauma. Heart Dis 2003; 5(3):184–186.CrossRefPubMedGoogle Scholar
  27. 27.
    Reiss J, Rassouk A, Kiev J, Bansal R, Bailey L. Concomitant traumatic coronary artery and tricuspid valve injury: a heterogeneous presentation. J Trauma 2001; 50(5):942–944.CrossRefPubMedGoogle Scholar
  28. 28.
    Nagy K, Krosner S, Roberts R, Joseph K, Smith R, Barrett J. Determining which patients require evaluation for blunt cardiac injury following blunt chest trauma. World J Surg 2001; 25:108–111.CrossRefPubMedGoogle Scholar
  29. 29.
    Forauer A, Dasika N, Gemmete J, Theoharis C. Pericardial tamponade complicating central venous interventions. J Vasc Intervent Radiol 2003; 14(2):255–259.Google Scholar
  30. 30.
    Hohlrieder M, Oberhammer R, Lorenz I, Margreiter J, Kuhbacher G, Keller C. Life-threatening mediastinal hematoma caused by extravascular infusion through a triple-lumen central venous catheter. Anesth Analg 2004; 99:31–35.CrossRefPubMedGoogle Scholar
  31. 31.
    Domino K, Bowdle T, Posner K, Spitellie P, Lee L, Cheney F. Injuries and liability related to central vascular catheters. Anesthesiology 2004; 100:1411–1418.CrossRefPubMedGoogle Scholar
  32. 32.
    Hsin S, Luk H, Lin S, Chan H, Tsou M, Lee T. Detection of iatrogenic cardiac tamponade by transesophageal echocardiography during vena cava filter procedure. Can J Anesth 2000; 47(7):638–641.CrossRefPubMedGoogle Scholar
  33. 33.
    Brown K, Getrajdman G. Balloon dilation of the superior vena cava (SVC) resulting in svc rupture and pericardial tamponade: a case report and brief review. Cardiovasc Intervent Radiol 2005; 28:372–376.CrossRefPubMedGoogle Scholar
  34. 34.
    Stassen N, Lukan J, Spain D, Miller F, Carrillo E, Richardson J. Reevaluation of diagnostic procedures for transmediastinal gunshot wounds. J Trauma 2002; 53(4):635–638.CrossRefPubMedGoogle Scholar
  35. 35.
    Nagy K, Roberts R, Smith R, et al. Trans-mediastinal gunshot wounds: are “stable” patients really stable? World J Surg 2002; 26:1247–1250.Google Scholar
  36. 36.
    Baker J, Battistella F, Kraut E, Owings J, Follette D. Use of cardiopulmonary bypass to salvage patients with multiplechamber heart wounds. Arch Surg 1998; 133(8):855–860.CrossRefPubMedGoogle Scholar
  37. 37.
    Golbasi Z, Cicek D, Ucar O, et al. Traumatic ventricular septal defect and mitral insufficiency after a Kebab’s Shish wound to the chest. Eur J Echocardiogr 2001; 2:203–204.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Matthew S. Slater
    • 1
  1. 1.Department of Cardiothoracic SurgeryOregon Health and Science UniversityPortlandUSA

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