Myocardial contusion without creatine kinase-MB elevation

Article Abstract:

A myocardial contusion is a bruise of the heart tissue which occurs between 10 to 76 percent of the time after a hard blow to the chest. Controversy exists as to the appropriate criteria for diagnosis for a myocardial contusion, but methods used usually include serial electrocardiography, echocardiography, and the monitoring of creatine kinase levels in the blood. Serial electrocardiography is a method that monitors the electrical activity of the heart over a period of a few days; echocardiography uses sound waves to visualize the heart; and creatine kinase is a protein that is released by damaged muscle into the circulation. All of these methods suffer from lack of accuracy, and care must be taken when using them to make a diagnosis of myocardial contusion. A recent report described a 26-year-old Southern New Jersey man who walked into the local Regional Trauma Center after being shot in the chest with a 22 caliber bullet. Electrocardiography showed no change in the electrical activity of his heart and echocardiography localized the bullet near the top left chamber of his heart. Creatine kinase levels were also normal. Four days later, the patient developed an infection and the bullet was removed. During surgery, a large bruise was observed in the left bottom chamber of his heart. His condition improved and he was discharged nine days after the initial injury. This report shows that creatine kinase levels, echocardiography, and electrocardiography may not provide the information that is needed for the diagnosis of a myocardial contusion. In a person that has multiple injuries, an elevated creatine kinase level only indicates that muscle has been damaged, it does not indicate which muscle has been damaged. Other methods are available to help with the diagnosis of muscle contusion, but they are expensive and have their own shortcomings. Further research is needed to develop an accurate diagnostic test for myocardial contusion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Diagnosis, Complications and side effects, Wounds and injuries, Heart, Echocardiography, Gunshot wounds

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Blood antibodies and uncrossmatched type O blood

Article Abstract:

Before a patient receives a blood transfusion, his blood type must be matched with the blood type of the person donating the blood. This is done because there are four different blood types. Three of the four blood types have different types of molecules (antigens) on the surface of the blood cells. Thus, type A blood has type A antigens, type B has type B antigens, type AB has both antigens, and type O has neither. If type A blood is mixed with type B or type AB, the blood will clot and red blood cells will be destroyed. This is called a transfusion reaction and it can occur when the blood of the donor is not matched with the blood of the recipient. Proper matching of the donor blood with the patient's blood involves mixing samples of the blood together on a microscope slide and looking for clotting and red blood cell destruction. It is estimated that transfusion reactions occur in 5 percent of the patients who receive blood that has been matched. Since people with type O blood do not have type A or B antigens, they are called universal donors, because their blood can be given to anyone. In emergency situations, such as resuscitation of trauma victims, it is not uncommon for patients to be given type O blood that has not been matched to their blood type (uncrossmatched blood). To determine the safety of this procedure, 135 severely injured patients receiving uncrossed matched type O blood were studied. None of the patients experienced a transfusion reaction. Sixty-one of the patients died, for reasons other than blood transfusion, and 76 underwent emergency surgery. Three of the surviving patients developed antibodies in their blood that could make it difficult to accurately crossmatch their blood with donor blood if they required another blood transfusion in the future. It is concluded that the use of uncrossmatched type O blood in emergency situations is safe, but in a few cases it may make future crossmatching difficult. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, Blood transfusion, Antigen-antibody reactions

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Electrocardiographic response to ice water ingestion

Article Abstract:

An electrocardiograph (ECG) is a recording of the electrical activity of the heart and is helpful in diagnosing such conditions as heart attacks. It is described as a wave having different parts with each part reflecting a different aspect of the heart contraction. One part, called the S-T segment, is frequently changed in heart attack patients, and another part called the T wave reflects the restoration of the electrical activity of the lower chambers of the heart to the resting state. Patients having a decrease in blood supply to the heart (ischemia) frequently develop both S-T and T wave changes on the ECG. In the hospital, 76 percent of heart attack patients are frequently restricted from having iced beverages in the coronary care unit (CCU). This is more strictly enforced by physicians than by nurses. It is thought that the ingestion of iced beverages causes changes in the ECG that are indicative of a decrease in blood flow to the heart, and may consequently aggravate a heart attack. A recent study examined 89 patients, who were admitted to the CCU to confirm or rule out the presence of a heart attack, to see if ice water ingestion could complicate the interpretation of the ECG. ECGs were obtained from patients at 3, 10, and 25 minutes after ingesting 200 or 400 milliliters of ice water. The ingestion of small amounts of ice water did not significantly change the patients' ECGs, but some patients did have slight ECG changes up to 30 minutes after ice water ingestion. It is recommended that heart attack patients be monitored for changes in their ECG when drinking iced beverages, and iced beverages should be restricted only if ECG changes develop. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Analysis, Prevention, Electrocardiogram, Cardiac patients, Ice, Silent myocardial ischemia

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