Diagnóza kontuze srdce?

Anest. intenziv. Med. 2003;14(2):85-89

Diagnosis of Myocardial Contusion?Articles

R. Šplechtna¹, L. Pokorný¹, E. Hušková¹, P. Obruba², J. Fialka³, D. Nalos¹: ¹ ARO, Masarykova nemocnice, Ústí nad Labem, přednosta MUDr. Daniel Nalos; ² Traumatologické centrum, Masarykova nemocnice, Ústí nad Labem, přednosta MUDr. Jan Houser; ³ Oddělení soudního lékařství, Masarykova nemocnice, Ústí nad Labem, přednosta MUDr. Jiří Fia

Objective:
Myocardial contusion can result from blunt thoracic trauma and is commonly suspected in deceleration injuries(after a traffic accident or a fall from great height etc.). Unfortunately, traumatic heart disease is frequently overlooked andthe diagnosis ofmyocardial contusion is often unrecognized. The diagnosis of cardiac injury in patients with blunt thoracictrauma is controversial. Non-invasive tests including ECG, cardiac enzymes, radionuclide studies and echocardiography(transthoracic echocardiography - TTE and especially transaesophageal echocardiography TEE) can be used.Many articlesconcerning methods of diagnosis of heart contusion were published recently. They brought no clear conclusions in termsof specificity and importance of these methods.

Design: retrospective study.Setting: ICU, Traumacentrum, Dep. of Forensic Medicine, Masaryk Hospital, Ústí nad Labem.

Materials and methods: Retrospective study of 102 patients with blunts chest injury.

Results: Myocardial contusion waspresented in 11.6%of our group.We observed the following incidence of positive findingsin the patients with myocardial contusion: 80% (CK-MB/CK), 86% (troponin I), 82% (ECG), 72% (transthoracic echocardiography- TTE).

Conclusion: The use of CK, CK-MB is useless for diagnosis of cardiac contusion. The most specific results were obtainedby the use of troponin I. It is necessary to combine several diagnostic methods.