A shocking bike accident. Issue 20 (20th July 2018)

• Record Type: Journal Article
• Authors: Spapen, Jerrold; Lochy, Stijn; Michiels, Vincent
• Is Part Of: Heart. Volume 104:Issue 20(2018)
• Page Start: 1706
• Page End: 1706
• Publication Date: 2018-07-20
• Subjects: pericardial tamponade -- cardiac computer tomographic (CT) imaging -- echocardiography; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/heartjnl-2018-313504
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Clinical introduction: A man in his late 40s presented with severe chest pain and progressive dyspnoea after hitting a tree at high speed during a bike ride in the woods. On admission, the patient appeared agitated, pale and sweaty. Core temperature was 35.5°C, respiratory rate 35/min and blood pressure 90/50 mm Hg with a regular pulse at 110 beats/min. Physical examination revealed multiple sternal bruises, distended jugular veins and muffled heart sounds (figure 1A ). Lactate level was 4.4 mmol/L (normal <2.0 mmol/L) and high-sensitivity cardiac troponin T 0.142 mcg/L (normal <0.005 mcg/L). An ECG and a total body CT scan were performed (figure 1B, C ). Question: What is the most likely diagnosis?: Inferior myocardial infarction with right ventricular involvement. Cardiac contusion with tamponade. Commotio cordis. Aortic laceration.