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(Circulation. 2008;117:e333-e335.)
© 2008 American Heart Association, Inc.

Images in Cardiovascular Medicine

Blunt Cardiac Injury

A Case Report

Hakim Morsli, MD; Gaby Weissman, MD; Howard A. Cooper, MD

From the Washington Hospital Center, Washington, DC.

Correspondence to Howard A. Cooper, MD, Division of Cardiology, Washington Hospital Center, 110 Irving St NW, Suite NA-1103, Washington, DC 20010. E-mail howard.a.cooper@medstar.net

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 53-year-old woman was kicked by her horse, with the hoof striking her in the center of the chest. She developed severe chest pain and was transported to our institution for treatment. Initial physical examination revealed a horseshoe-shaped contusion in the central chest (Figure 1). Cardiac auscultation was normal. Rib radiographs did not reveal any fractures. A chest x-ray showed clear lung fields and a normal cardiac silhouette (Figure 2). A 12-lead ECG demonstrated sinus tachycardia with a minor right ventricular conduction delay and no ischemic changes (Figure 3). Serum troponin I was elevated (3.60 ng/mL, normal <0.08 ng/mL). Two-dimensional transthoracic echocardiography revealed a partially flail septal leaflet of the tricuspid valve (Figure 4, online-only Data Supplement Movie I). Color Doppler demonstrated an anteriorly-directed jet of tricuspid regurgitation of moderate severity (Figure 5, online-only Data Supplement Movie II). Cardiac magnetic resonance imaging confirmed these findings (Figure 6, online-only Data Supplement Movie III). The tricuspid regurgitant volume was calculated at 25 cm³, yielding a regurgitant fraction of 32% (Figure 7). The patient received narcotics for pain control and was discharged home after 48 hours of electrocardiographic monitoring. At 4 months, the patient remains free of symptoms and has resumed training horses.

View larger version (122K):   Figure 1. Photograph showing the horseshoe-shaped contusion in the central chest.

View larger version (130K):   Figure 2. Chest x-ray, posteroanterior view.

View larger version (128K):   Figure 3. Twelve-lead ECG.

View larger version (102K):   Figure 4. Two-dimensional transthoracic echocardiogram demonstrating a partially flail septal leaflet of the tricuspid . . . [Full Text of this Article]