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Heart failure due to apical intramyocardial dissecting hematoma and compressing pleural hematoma in polytraumatic patient

Elena Kinova

Cardiology Department, University Hospital “Tsaritsa Yoanna – ISUL”, Sofia, Bulgaria

Angelina Borizanova

Cardiology Department, University Hospital “Tsaritsa Yoanna – ISUL”, Sofia, Bulgaria

Natalia Spasova

Cardiology Department, University Hospital “Tsaritsa Yoanna – ISUL”, Sofia, Bulgaria

Assen Goudev

Cardiology Department, University Hospital “Tsaritsa Yoanna – ISUL”, Sofia, Bulgaria

DOI: 10.15761/JIC.1000228

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75 year-old-man was presented at Emergency department after falling from the second floor. Left-sided rib fractures with haemothorax and pneumothorax (Figure 1), and hemoperitoneum were diagnosed. ECG showed sinus rhythm, pathologic R-wave progression in V1-4 and repolarization abnormalities (Figure 2). Echocardiography revealed left ventricle (LV) with normal size and ejection fraction (EF) 53%. There were no cardiac mechanical complications and pericardial effusion. Lung drainage and abdominal laparoscopy performed immediately.

Figure 1. Chest X-ray at admission.

On the next day patient represented with hypotension, high dose catecholamine infusion was started to maintain RR 90-95/60 mmHg. There was no breathing in the left chest and new systolic murmur with punctum maximum at the left lower sternal edge was heard. High-sensitivity Troponin I reached 416 pg/ml. Echocardiography revealed LV apical dyskinesia and additional cavity with systolic expansion and thin wall, separated from LV cavity – intramyocardial dissecting hematoma (Figure 3). No color Doppler flow was visualized in this structure (Figure 4). Lateral wall was hypokinetic, EF dropped to 35%. There was a huge mass with characteristic of pleural hematoma with severe compression of left atrium (Figure 5). Mitral inflow was reduced with E-wave 48 cm/s and E/A ratio 1.1. Severe tricuspid regurgitation was registered. The patient died on the 10-th day because of progressing respiratory and heart failure despite improved LV function and absence of pericardial effusion.

Figure 2. ECG at admission.

Figure 3. 2D-echocardiography, left ventricular apex with intramyocardial dissecting hematoma.

Figure 4. Short axis apical view, additional cavity (intramyocardial hematoma) without color Doppler flow.

Figure 5. 3-chamber apical view, large pleural hematoma behind left ventricular posterior wall with compression of left atrium.

This case represented a rare combination of blunt cardiac injury with intramyocardial dissecting hematoma and heart compression from large pleural hematoma, which should be considered in polytrauma.

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Editor-in-Chief

Article Type

Case Report

Publication history

Received: September 14, 2017
Accepted: October 05, 2017
Published: October 07, 2017

Copyright

©2017 Kinova E. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Kinova E, Borizanova A, Spasova N, Goudev A (2017) Heart failure due to apical intramyocardial dissecting hematoma and compressing pleural hematoma in polytraumatic patient. Cardiol Case Rep 1: DOI: 10.15761/JIC.1000228

Corresponding author

Elena Kinova, MD, PhD

Cardiology Department, University Hospital “Tsaritsa Yoanna – ISUL” “Byalo more” Str. №8, 1527 Sofia, Bulgaria

Figure 1. Chest X-ray at admission.

Figure 2. ECG at admission.

Figure 3. 2D-echocardiography, left ventricular apex with intramyocardial dissecting hematoma.

Figure 4. Short axis apical view, additional cavity (intramyocardial hematoma) without color Doppler flow.

Figure 5. 3-chamber apical view, large pleural hematoma behind left ventricular posterior wall with compression of left atrium.