ISOLATED RIGHT-SIDED HEART FAILURE WITH CARDIOGENIC SHOCK SECONDARY TO BLUNT CHEST TRAUMA AND MYOCARDIAL CONTUSION

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: The right ventricle is the most proximal cardiac structure to chest wall and commonly injured during motor vehicle accidents blunt trauma. However, isolated ventricular failure an uncommon presentation of Here we report a case heart cardiogenic shock in setting trauma myocardial contusion. CASE PRESENTATION: A 59-year-old female with history rheumatoid arthritis, attention deficit hyperactivity disorder, cerebral palsy was brought emergency department after sustaining accident, complaining pain her lower extremity. She hemodynamically stable. Trauma work up revealed tibial shaft plateau fracture increased troponin levels but without EKG evidence ischemia. Her condition deteriorated progressive hypoxemic respiratory failure, lactic acidosis, profound multiorgan failure. CT contrast negative for pulmonary embolism. Echocardiography severe dilation dysfunction, septal flattening preserved left function, no pericardial effusion. Estimated systolic pressure 40 mmHg, tricuspid regurgitant velocity 2.8 m/s, estimated atrial = 15 mmHg. patient treated vasoactive agents including inotropes, supplemental oxygen renal replacement therapy, improvement systemic perfusion eventually weaned off agents. repeated echocardiogram showed normal biventricular function. catheterization artery right-sided pressures, decreased filling pressures output. discharged home once clinically DISCUSSION: Cardiogenic rare lethal complication Blunt injury can be manifested by or valvular rupture, tamponade dysfunction.1However, unusual injury. Other etiologies such as thromboembolic disease ischemia were ruled out. Treatment directed towards underlying etiology, supportive care use inotropes and/or vasodilators, consideration mechanical circulatory support refractory cases.2 CONCLUSIONS: Right develop Early suspicion recognition are essential proper management. REFERENCE #1: Tenzer ML. spectrum contusion: review. J Trauma. 1985;25(7):620-627. #2: Chavanon O, Dutheil V, Hacini R, Borrel E, Tremel F, Blin D. contusion assist device multiple Thorac Cardiovasc Surg. 1999;118(1):189-190. DISCLOSURES: No relevant relationships Roberto Bernardo, source=Web Response Samiksha Gupta, Adam Przebinda, disclosure on file Aejaz Ul Haq