Commotio Cordis – ABC CARDIOL

ABCIC

Case Report

Atrial Fibrillation and Tricuspid Regurgitation as Late Presentations of Contusio Cordis

Marcos Merula de Almeida et al. Noemí Rocío Andrade Alban Galo Juvenal Vinueza Aguay

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IJCS

Case Report

Commotio Cordis Secondary to Aggression

Luisa Gonçalves et al. Inês Pires João Santos Joana Laranjeira Correia … Davide Moreira Inês Almeida

Case report

A 35-year-old man was admitted following a recovered cardiorespiratory arrest. He was attacked by another man with multiples blunts by a wood stick in the chest and head. An eyewitness statement indicated that the victim had lost consciousness and collapsed after being hit in the chest. He was in cardiac arrest, and a nearby healthcare professional provided first aid with cardiopulmonary resuscitation. The first electrocardiogram (ECG) rhythm strip, fifteen minutes later, identified ventricular fibrillation (VF) (). Sixteen electrical shocks were delivered, always with VF, before restoration of sinus rhythm and circulation. A 12-lead-ECG revealed sinus rhythm without ST deviations and a corrected QT interval of 414 msec. On admission, he was under ventilatory support, with a heart rate of 80 beats per minute, blood pressure of 121/70mmHg, and no signs of shock. There was no previously known medical condition, besides being an active smoker and a binge drinker, and no family history of early coronary disease, cardiomyopathy, or sudden death. He was under the influence of alcohol, as was confirmed by blood tests (blood alcohol level of 1.31g/L), and had a discretely elevated cardiac troponin-T of 0.9ng/ml (normal range, 0 to 0.08 ng/ml). The remaining analyzes, cranial and cervical CT scan, chest X-ray, and abdominal eco FAST were normal. An initial echocardiogram in the emergency department demonstrated normal-sized chambers and global ventricular systolic dysfunction explained by a prolonged cardiac arrest. He was admitted to the intensive care unit for post-resuscitation care with therapeutic hypothermia and temporary ventilatory support. At 48 hours of admission, there was a normalization of systolic function with a normal ejection fraction by echocardiogram (). Coronary angiography excluded coronary disease (). Serial electrocardiograms were not suggestive of an arrhythmogenic substrate (). The sudden cardiac arrest was assumed secondary to a commotio cordis (CC), and for this reason, the patient was not proposed for an implantable cardioverter-defibrillator (ICD). The clinical outcome was favorable, and the patient was discharged. He remained asymptomatic during three years of follow-up, with normal ECG, echocardiogram with strain-rate imaging, exercise stress test, and 24-hour-Holter. During mid-term follow-up, a cardiac magnetic resonance imaging (MRI) showed normal-sized chambers, global and regional function, and no myocardial edema or myocardial scar by late focal hyperenhancement (-).

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ABC

Case Report

Contusio Cordis Associated with Atrioventricular Block and Tricuspid Regurgitation

Giulio Cesare Longo Neto et al. Wolney de Andrade Martins Humberto Villacorta Junior Eduardo Nani da Silva … Paula Maira Alves Haffner Davyson Gerardt de Souza

Introduction

The expression “contusio cordis” defines a lesion of the cardiac myocyte, hemorrhagic or fibrotic, due to the application of violent kinetic force resulting from a blunt trauma to the precordial region. Syncope is almost always the first clinical manifestation observed, and commonly precedes death. Contusio cordis differs from commotio cordis, the latter representing a cardiac electromechanical disorder consequent to a blunt trauma to the precordial region, at a critical moment of the cardiac cycle, which occurs within 10 to 30 ms from the T-wave peak, a period susceptible to the development of ventricular fibrillation ^– . Both forms are fatal most of the time ^, ^, ^– . Commotio cordis is a form of ventricular fibrillation, rather than a lesion in cardiomyocytes or adjacent organs ^, . It is a rare condition, leading most cases to death , and being more prevalent among men, because of its relationship to high-impact sports ^, . The accurate incidence of both entities is unknown, because there is no systematic way to register all cases; however, although rare in the literature, they are believed to be more common than reported ^, . Contusio cordis associated with complete atrioventricular block (CAVB) is an even rarer condition, with few cases reported. The objective of the present study is to report a case of contusio cordis associated with CAVB and tricuspid regurgitation (TR).

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Atrial Fibrillation and Tricuspid Regurgitation as Late Presentations of Contusio Cordis

Commotio Cordis Secondary to Aggression

Case report

Contusio Cordis Associated with Atrioventricular Block and Tricuspid Regurgitation

Introduction

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