ECG in penetrating cardiac injury

[M G Reeds]

Sa'ad,

I once questioned the role of ECGs in demonstrating penentrating cardiac 
injury. Unfortunately, I never got round to conducting a full review of 
the literature but I have cited a few articles below which I 
provisionally found some time ago.

I am not aware of any significantly powered and properly conducted 
studies to demonstrate the effectiveness of ECGs (I would nevertheless be 
keen to hear from others on the list who have any enlightening data 
either way.) My belief is that it does not have any real role as there 
have been a number of penetrating cardiac injuries documented which do 
not demonstrate any ECG changes and would have been missed if relied upon 
as a single diagnostic test.


Absence of hemodynamic and ECG changes in a patient with traumatic left 
ventricular injury and puncture of the left anterior descending branch. 
Südkamp M, Geissler HJ, de Vivie ER. Thorac Cardiovasc Surg. 2000 Dec;48
(6):373-5.

Penetrating cardiac trauma: follow-up study including 
electrocardiography, echocardiography, and functional test. Duque HA, 
Florez LE, Moreno A, Jurado H, Jaramillo CJ, Restrepo MC. World J Surg. 
1999 Dec;23(12):1254-7. (About post-operative monitoring NOT diagnostics)

Dysrhythymia from an intrapericardial air gun pellet: a case report. 
Willemsen P, Kuo J, Azzu A. Eur J Cardiothorac Surg. 1996;10(6):461-2. 
(Anecdotal case.)


The literature mostly refers to echocardiography being a much more useful 
test (greater sensitivity and specificity.) Although the last publication 
above refers to ECG changes being better at diagnosing penetrating 
cardiac injury in that particular case than echocardiography.

I feel that nothing can compare to appropriate histroy, examination of 
the patient, mechanism of injury (e.g. knife stab wound to anterior chest 
= high probability of cardiac injury until proved otherwised etc.) and 
echo/FAST etc. are more appropriate in making a proper diagnosis.


Matthew