Clinical Communications: Adults
Complete Atrioventricular Block Associated with Non-penetrating Cardiac Trauma in a 40-year-old Man

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Abstract

Background

Myocardial contusion is a rare complication of blunt chest trauma. Transient conduction and rhythm problems, right ventricular dysfunction, or pulmonary embolism may occur after chest trauma, but these complications almost always occur early in the post-operative period.

Objectives

The objective is to describe a case illustrating that trauma may induce high-grade atrioventricular block.

Case Report

We report the case of a patient who developed delayed onset of complete atrioventricular block after transient complete atrioventricular block and alternating bundle branch block secondary to blunt chest trauma.

Conclusion

Even with an injury that does not seem to be caused by direct penetrating trauma to the heart, maybe every trauma patient needs an electrocardiographic evaluation. It is important to note that myocardial healing is a continuous process after trauma, and additional pathology may be revealed later in the course of healing from myocardial contusion.

Introduction

Cardiac injury occasionally occurs as a result of blunt chest trauma (1). The presence and severity of cardiac injury is dependent on the magnitude of force applied to the chest wall, where it is applied, the compliance of the chest wall, and the timing of the application of force during the cardiac cycle. In one report, the prevalence of cardiac complications in trauma patients varied between 2.6% and 4.5% (1). Symptoms and physical signs are often non-specific. An initial abnormal electrocardiogram (ECG) may be helpful to identify patients with cardiac injuries that alter the electrical properties of the heart. Cardiac isoenzymes alone are not helpful. The role of troponin levels is not yet clear. Echocardiography is useful in the evaluation of clinically severe blunt cardiac injury (2). Because the right heart is quite superficial, it is more often affected than the left. Motor vehicle accidents, in particular steering wheel injuries, are the most common cause of cardiac injury in trauma patients (3). Others include falls from heights, sports accidents, and animal kicks (4). We report the case of a patient with trauma-induced complete atrioventricular block as a late complication of blunt chest trauma.

Section snippets

Case Report

A previously healthy 40-year-old man presented to the Emergency Department (ED) of a local hospital with blunt chest and head trauma after a robbery. He did not have a family history of cardiovascular disease. He had a direct blow to the mid sternum and anterior and lateral aspects of 4–7 ribs with fists and kicks. The physical examination was normal except for tenderness and bruises on the mid sternum, lateral and anterior aspects of 4.–7. ribs, and hemorrhage from the nose. Chest X-ray study

Discussion

Pathological changes may occur in myocardial contusion, such as myocardial cell necrosis, erythrocyte extravasation, and leukocyte infiltration (5). There are some similarities between acute myocardial infarction and myocardial contusion. Scar tissue formation during the healing process may cause late complications in myocardial contusion (6). The clinical criteria for the diagnosis of myocardial contusion in the acute stage remain uncertain, and the importance and significance of the diagnosis

Conclusion

Even when there is traumatic injury that seems unrelated to direct penetrating trauma to the heart, every trauma patient may need an electrocardiographic evaluation. Furthermore, it must be kept in mind that myocardial healing is a continuous process that may result in an abnormality later in its course.

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