Traumatic injury of the heart: Incidence of its occurrence in forty-two cases of severe accidental bodily injury

Abstract

A study was made of the incidence of trauma of the heart in forty-two cases of rather serious accidental injuries to the body. In thirty-two, or 76.2 per cent, there was demonstrable evidence of some cardiac damage, clinical, electrocardiographic, or both. In some cases the damage occurred even if the blow did not affect the chest, provided it was of sufficient severity to result in marked bodily injury. In most cases the damage appeared to be very mild and short-lived. In some it was severe. In many cases there were either no subjective manifestations referable to the heart or the manifestations were trivial. Precordial pain or discomfort and slight dyspnea were the main complaints. The objective manifestations consisted of abnormalities in the heart sounds, the presence of a gallop rhythm, a pericardial friction rub, and systolic murmurs, in various areas. The findings were short-lived and occurred in comparatively few cases. The electrocardiographic manifestations consisted of changes in the voltage and appearance of the QRS complex from time to time and some shift in the electrical axis; elevation, rounding with upward concavity, and occasional coving of the R-T segment; and frequent changes in the T wave from positive to isoelectric and negative and back to positive. In the majority of cases the electrocardiographic changes were nonspecific. In occasional cases, they were characteristic of pericardial involvement, or of localization of the damage to other specific areas of the heart. Complete recovery took place in nearly all cases in this series. Only one patient showed permanent damage and in another case the cardiac injury was at least partly responsible for death. The observations tend to indicate that trauma of the heart is a rather frequent occurrence in serious bodily injuries and call for future unbiased investigation of this subject.