Cases reported "Heart Injuries"

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1/8. Intra-aortic balloon counterpulsation for cardiogenic shock due to cardiac contusion in an elderly trauma patient.

    Blunt thoracic trauma may cause cardiac contusion and cardiogenic shock resistant to inotropic support. The use of intra-aortic balloon counterpulsation (IABCP) as a mechanical means of augmenting cardiac function following cardiac contusion is rare with case reports largely limited to its use in young trauma patients. We describe the case of a frail, 80-year-old woman who suffered cardiac contusion in a motor vehicle crash. She developed cardiogenic shock with electrocardiograph changes, elevated troponin t and severe global dysfunction on echocardiography. She was successfully managed with invasive monitoring, inotropic support and IABCP. This case provides support for aggressive resuscitation even in the very elderly as recovery from severe cardiac contusion may be possible.
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ranking = 1
keywords = counterpulsation
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2/8. Intra-aortic balloon counterpulsation in penetrating cardiac trauma.

    A case is presented in which the intra-aortic balloon pump (IABP) was used to successfully manage cardiogenic shock in a patient with a cardiac stab wound, not involving a coronary artery.
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ranking = 0.8
keywords = counterpulsation
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3/8. Simultaneous papillary muscle avulsion and free wall rupture during acute myocardial infarction. Intra-aortic balloon pump: a bridge to survival.

    Mechanical complications of acute myocardial infarction (AMI) are rare, but often fatal. Medical therapy does not provide adequate risk reduction, and surgical correction is recommended when feasible. Supplemental hemodynamic support utilizing intra-aortic counterpulsation with a balloon pump provides an improvement in morbidity and mortality when combined with a corrective surgical approach. We report a case of an elderly male with a progressive 2-week history of ischemic symptoms presenting with acute pulmonary edema, hypotension and an inferior wall ST-elevation MI. His hospital course was complicated by ischemic mitral regurgitation (MR) and cardiogenic shock, which resulted in a papillary muscle rupture/avulsion from the inferolateral myocardial wall, and a communication for blood from ventricle to pericardial space. Initial management included mechanical ventilation, pharmacologic inotropic support, percutaneous revascularization of the culprit lesion and intra-aortic balloon counterpulsation. The patient underwent further successful cardiovascular surgical correction of his incompetent mitral valve, free wall rupture and other obstructive coronary arteries, leading to discharge and survival. Mechanical complications from AMI and the role of intra-aortic balloon support are discussed.
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ranking = 0.4
keywords = counterpulsation
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4/8. Intra-aortic balloon pump for combined myocardial contusion and thoracic aortic rupture.

    The coexistence of myocardial contusion and thoracic aortic injury is probably more common than recognized following rapid deceleration multisystem trauma. This report describes the successful application of intra-aortic balloon counterpulsation in a critically injured patient requiring emergent repair of a thoracic aortic tear complicated by ventricular failure due to cardiac contusion.
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ranking = 0.2
keywords = counterpulsation
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5/8. The intra-aortic balloon pump as an adjunctive therapy for severe myocardial contusion.

    The management of patients with post-traumatic myocardial contusion requires close electrocardiographic and hemodynamic monitoring. When complications such as cardiogenic shock occur, aggressive treatment using Swan-Ganz catheterization for monitoring of intravascular volume and cardiac inotropic support are necessary. Failure to restore hemodynamic stability using these measures is an indication for the use of intra-aortic balloon pump counterpulsation. A case of successful management of a patient with post-traumatic myocardial contusion complicated by refractory cardiogenic shock using intra-aortic balloon pump counterpulsation is presented. Use of the intra-aortic balloon pump improved cardiac output, eventually resulting in hemodynamic stabilization.
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ranking = 0.4
keywords = counterpulsation
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6/8. Intra-aortic balloon counterpulsation in blunt cardiac injury.

    Intra-aortic balloon counterpulsation (IABC) is a widely used form of mechanical circulatory assistance. We have successfully employed IABC in three patients with refractory cardiogenic shock secondary to cardiac contusion. All patients had multiple blunt injuries with cardiac contusion documented electrocardiographically, by CPK isoenzyme determinations, and clinically. IABC was instituted for hypotension refractory to vasoactive drugs and optimization of intravascular volume status. cardiac output and blood pressure rose in all cases and fewer ventricular arrhythmias were noted. Discontinuation of IABC was possible within 48 hours in all cases with adequate cardiac performance. We conclude that IABC is a useful approach in the treatment of refractory cardiogenic shock associated with cardiac contusion.
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ranking = 1
keywords = counterpulsation
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7/8. Intra-aortic balloon counterpulsation for cardiogenic shock from cardiac contusion.

    Two patients who sustained cardiac contusions secondary to blunt chest trauma developed refractory cardiogenic shock. Use of intra-aortic balloon counterpulsation improved circulatory dynamics in each case and one patient survived. Requirements for inotropic agents were diminished or eliminated, cardiac output was increased, acidosis was reversed, and the electrocardiogram reverted to normal. Although balloon counterpulsation is most effectively employed in patients with ischemic cardiac deficits, its early application coupled with appropriate pharmacologic treatment is also effective in raising low cardiac output that results from myocardial trauma.
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ranking = 1.2
keywords = counterpulsation
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8/8. Use of the intra-aortic balloon support for refractory low cardiac output in myocardial contusion.

    A patient with refractory low cardiac output and recurring ventricular arrhythmias resulting from myocardial contusion was treated with intra-aortic balloon counterpulsation. Use of the intra-aortic balloon resulted in an increased cardiac output and control of the ventricular arrhythmias. After 1 year the patient shows no sequelae of myocardial contusion, although he is still paraplegic.
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ranking = 0.2
keywords = counterpulsation
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