Kardiyak Travma ve Kontüzyon
Özet
Kardiyak travmalar, nadir görülmelerine rağmen yüksek ölüm oranına sahip ciddi durumlardır. Bu yaralanmalar, hafif kontüzyondan ölümcül rüptürlere kadar geniş bir yelpazede ortaya çıkabilir. Künt ve penetran olmak üzere iki temel mekanizması vardır; penetran torasik travma geçiren hastaların %6’sında kalp yaralanması görülür. En sık ölüm nedenleri miyokard rüptürü ve koroner arter hasarlarıdır. Ventriküler fibrilasyon ise, kalp repolarizasyonu sırasında alınan darbelere bağlı olarak gelişebilir.
Başlıca semptomlar göğüs ağrısı, nefes darlığı ve çarpıntıdır. Fizik muayenede taşipne, sternum hassasiyeti ve göğüste emniyet kemeri izi gibi bulgular görülebilir. Tanıda FAST ve EKG kritik rol oynar; hemodinamik sorunları olan hastalarda kardiyak biyobelirteçler ve ileri görüntüleme yöntemleri kullanılabilir.
Tedavi, yaralanmanın türüne ve hastanın durumuna göre planlanır. Yüksek troponin düzeyi veya anormal EKG bulguları olan hastalar 24-48 saat süreyle kardiyak izleme alınmalıdır. Travmanın türü ve ek komplikasyonlar mortalite ve morbiditeyi belirler. Künt travma geçiren hastalar, gecikmiş rüptür veya tamponad gibi sorunlara karşı 3-6 ay içinde yeniden değerlendirilmelidir.
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