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‘Focal’ Cardiac Concussion – An Under-Recognized Problem?

Case report

Abstrak

Gegaran jantung merupakan hentakan tumpul, mengejut terhadap bahagian dada yang boleh menyebab kematian. Walaubagaimanapun, terdapat sebahagian pesakit tidak memenuhi definisi tersebut. Kami melaporkan dua kes yang tidak memenuhi domain definisi tersebut. Dua mangsa lelaki mendapatkan rawatan di Jabatan Kecemasan dengan kesakitan dada sederhana selepas terlibat dalam kemalangan jalan raya. Didapati paras ST meningkat pada led dada V2 dan V3 serta peningkatan paras kreatin kinase dantropnin T.  Elektrokardiogram tersebut balik ke paras biasa selepas 24 jam. Mereka discas dengan selamatnya selepas 24 jam rawatan di wad sementara Jabatan Kecemasan. Definisi gegaran jantung (commotion cordis) konvensional dan lebam jantung adalah tidak sesuai untuk mengambarkan keadaan kes-kes tersebut. Oleh itu, kami mencadangkan diagnosis gegaran jantuang setempat (fokus). Kami juga ingin menekankan kebolehan Jabatan Kecemasan untuk memantau dan merawat pesakit-pesakit golongan ini di wad sementara jabatan ini.  

Abstract

Cardiac concussion is a sudden, direct blunt trauma cause to the chest which led to death. However, there are patients who did not completely fulfil this definition. We report two cases which did not fit into the definition domain. Two male patients presented to Emergency Department with moderate anterior chest pain after motor vehicle crash showed transient anterior ST segment elevation at chest lead V2 and V3 with raised creatine kinase and normal troponin T. The electrocardiogram changes fully resolved after 24 hours. Both patients were discharged uneventfully after 24 hours monitoring in Emergency Department short-stay ward. Conventional definition of cardiac concussion (commotion cordis) and cardiac contusion may be unsuitable to describe these cases. Therefore, we propose the diagnosis of focal cardiac concussion. We also highlighted the ability of Emergency Department to manage these patients in short-stay ward.