A case report of blunt cardiac rupture

Abstract

Introduction: Cardiac rupture is a full thickness laceration of the myocardium that occurs after blunt chest trauma. They are notoriously fatal, with only a handful of patients documented to have survived. These injuries are not commonly associated with low energy chest trauma and may be overlooked as a differential in trauma cases if health care providers are not aware of their possibility. We now report the case of a patient who survived this injury. We believe this is the 16th reported survivor of blunt cardiac rupture.

Presentation of case: A 46-year-old construction worker was brought to the emergency department following blunt chest trauma. On arrival he was hypotensive and tachycardic. There was a transient response to intravenous fluid resuscitation. He was found to have a contusion to the left anterior chest wall and left haemothorax on imaging with normal mediastinum. Emergency left anterolateral thoracotomy revealed a pericardial and left ventricular laceration which was repaired. He was weaned off ventilatory support on day 4 post exploration and had an uneventful recovery.

Discussion: Survival after blunt cardiac rupture is extremely low. In the past 60 years, only 15 cases have been described where patients survived this injury. They are usually immediately fatal and are caused by high velocity injuries. Our case was interesting because, this injury was due to a low velocity injury resulting in ventricular laceration due to a displaced rib fracture. We believe this is the 16th reported survivor of blunt cardiac rupture.

Conclusion: It is important, therefore, for first responders to recognize that blunt cardiac rupture can also result from seemingly innocuous, low velocity injuries so that the diagnosis can at least be entertained early. Survival depends on early diagnosis and prompt thoracotomy.

Keywords: Blunt cardiac trauma; Cardiac tamponade; Chest trauma; Haemothorax; Rib fracture; Thoracotomy.