Parshotam Lal Gautam1, Neeru Luthra2, Manpreet Kaur3, Jaspal Singh4, Gurpreet Singh Wander5, Rohit Tandon5, Nikhil Gautam6. 1. Professor, Department of Critical Care, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. 2. Assistant Professor, Department of Anaesthesia, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. 3. Ex Senior Resident, Department of Anaesthesia, Max Hospital, Mohali, Punjab, India. 4. Professor, Department of Surgery, Dayanand Medical College and Hospital, Lludhiana, Punjab, India. 5. Professor, Department of Cardiology, Hero Dmc Heart Institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India. 6. Intern, Department of Surgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Abstract
INTRODUCTION: Myocardial contusion is an entity in chest trauma which is difficult to diagnose. Current practice relies more on cardiac-specific biochemical markers and standard echocardiography, but no gold standard test exists. The application of Tissue Doppler imaging is yet unexplored. AIM: The present study was designed to evaluate cardiac injury in patients with blunt trauma chest using conventional trans-thoracic echocardiography parameters and Tissue Doppler imaging. MATERIALS AND METHODS: After ethical approval was taken from the Hospital and University and a written informed consent from all patients/attendants, this prospective study was conducted on a total of 30 patients in range of 15-60 years of age with blunt trauma chest. Patients with positive Trop-T and raised CPK (> 308 IU/L), raised CK-MB (> 24 IU/L) levels were suspected to have myocardial injury and were enrolled in the study. All patients fulfilling the inclusion criteria then underwent 2D-Echo and Tissue Doppler Imaging. Results of the observations were analysed using chi-square test. RESULTS: Out of the total of 30 patients, 63.3% showed ECG changes suggestive of cardiac injury. A 76.7% patients suffered systolic dysfunction and 36.6% patients suffered diastolic dysfunction irrespective of ECG changes. On comparison of early filling velocity wave i.e., E wave (measured by transthoracic echocardiography) and tricuspid annular velocity Em wave (measured by tissue Doppler echocardiography) at tricuspid valve, we found statistically significant difference among two techniques. (p = 0.04). CONCLUSION: Echocardiography is very sensitive parameter for evaluation of myocardial contusion. Tissue Doppler imaging provides additional and reliable information.
INTRODUCTION: Myocardial contusion is an entity in chest trauma which is difficult to diagnose. Current practice relies more on cardiac-specific biochemical markers and standard echocardiography, but no gold standard test exists. The application of Tissue Doppler imaging is yet unexplored. AIM: The present study was designed to evaluate cardiac injury in patients with blunt trauma chest using conventional trans-thoracic echocardiography parameters and Tissue Doppler imaging. MATERIALS AND METHODS: After ethical approval was taken from the Hospital and University and a written informed consent from all patients/attendants, this prospective study was conducted on a total of 30 patients in range of 15-60 years of age with blunt trauma chest. Patients with positive Trop-T and raised CPK (> 308 IU/L), raised CK-MB (> 24 IU/L) levels were suspected to have myocardial injury and were enrolled in the study. All patients fulfilling the inclusion criteria then underwent 2D-Echo and Tissue Doppler Imaging. Results of the observations were analysed using chi-square test. RESULTS: Out of the total of 30 patients, 63.3% showed ECG changes suggestive of cardiac injury. A 76.7% patients suffered systolic dysfunction and 36.6% patients suffered diastolic dysfunction irrespective of ECG changes. On comparison of early filling velocity wave i.e., E wave (measured by transthoracic echocardiography) and tricuspid annular velocity Em wave (measured by tissue Doppler echocardiography) at tricuspid valve, we found statistically significant difference among two techniques. (p = 0.04). CONCLUSION: Echocardiography is very sensitive parameter for evaluation of myocardial contusion. Tissue Doppler imaging provides additional and reliable information.
Authors: D G Karalis; M F Victor; G A Davis; M P McAllister; V A Covalesky; J J Ross; R V Foley; M D Kerstein; K Chandrasekaran Journal: J Trauma Date: 1994-01