Cardiac Stab Wound in Remote Area: A Case Report
DOI:
https://doi.org/10.35790/ecl.v13i2.61045Abstract
Abstract: Penetrating cardiac injuries are life-threatening emergencies requiring immediate surgical intervention. We presented a case of cardiac stab wound leading to cardiac tamponade and rupture of the pulmonary artery and right ventricle who survived long enough to undergo emergency procedure. A 25-year-old male was stabbed in the left chest approximately nine hours before admission. He experienced chest pain and dyspnea but remained conscious. After initially treated at a local hospital, he was later referred to a tertiary facility. On assessment, he was tachycardic, tachypneic, and had distant heart sounds. Laboratory findings revealed leukocytosis, thrombocytosis, hyperglycemia, metabolic acidosis, lactic acidosis, and anemia. Chest radiograph showed a bottle-shaped heart, passive atelectasis, and a rightward shift of the thoracic vertebrae. The initial suspicion was cardiac tamponade due to myocardial rupture. Sternotomy revealed a pericardial hematoma (150 mL), a right ventricular tear extending to the pulmonary artery, and pneumothorax. Surgical repair was performed with drainage placement. After intervention, echocardiograph examination showed no myocardial damage or infarction, a dysfunction in diastolic which showed an impaired in relaxation of the left ventricle which is a temporary consequence of trauma, pericardial effusion or surgical intervention. In conclusion, this case underscores necessity of early surgical intervention even if this patient succeeded surviving for long hours before surgery. While this patient showed promising recovery, close postoperative monitoring remains crucial to detect functional changes and prevent complications.
Keywords: emergency sternotomy; vulnus ictum; chest trauma; sharp cardiac injury; repair of artery pulmonary; rupture of right ventricle
References
Stashko E, Meer JM. Cardiac Tamponade. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431090/
Yousuf MS. Ullah H. Anesthetic management of stab wound in right ventricle of heart. Saudi J Anaesth. 2019;13(4):356-8. Doi: 10.4103/sja.SJA_2_19
Cardiovascular Medicine. Electrical alternans: the ECG in pericardial effusion and cardiac tamponade [Internet]. [cited 14 February 2025]. Available from: https://ecgwaves.com/topic/pericardial-effusion-cardiac-tamponade-electrical-alternans-ecg/
Piña IL, Cohen PD, Larson DB, Marion LN, Sills MR, Solberg LI, et al. A framework for describing health care delivery organizations and systems. Am J Public Health. 2015;105(4):670-9. Doi: 10.2105/AJPH.2014.301926
Eskandari M, Abbaszadeh A, Borhani F. Barriers of referral system to health care provision in rural societies in Iran. J Caring Sci. 2013;2(3):229-36. Doi: 10.5681/jcs.2013.028.
Pappinen J, Nordquist H. Driving speeds in urgent and non-urgent ambulance missions during normal and reduced winter speed limit periods-a descriptive study. Nurs Rep. 2022;12(1):50-8. Doi: 10.3390/nursrep12010006
Popal Z, Schepers T, Schie PV, Giannakopoulos GF, Halm JA. The use of routine laboratory testing in acute trauma care: A retrospective analysis. Ulus Travma Acil Cerrahi Derg. 2022;28(7):954-9. Doi: 10.14744/tjtes.2021.14826
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Sciences Policy; Committee on Security of America's Medical Product Supply Chain; Shore C, Brown L, Hopp WJ, editors. Preparedness measures for resilient medical product supply chains. In: Building Resilience into the Nation's Medical Product Supply Chains [Internet]. Washington (DC): National Academies Press (US); 2022 Mar 3. Available from: https://www.ncbi.nlm.nih.gov/books/NBK583738/
Solutions for tomorrow. How a portable X-ray system improves clinical workflows and minimizes stress [Internet]. [cited 2025 Feb 19]. Available from: http://solutionsfortomorrow.se/how-using-mobile-x-ray-technology-improves-workflow-and-reduces-stress/
Preventive Maintenance Medical. Sterile processing equipment [Internet]. Mount Vernon (OH): Preventive Maintenance Medical. [cited 2025 Feb 19]. Available from: https://preventivemaintenancemedical.com/sterile-processing-equipment/
Rutala WA, Weber DJ. Disinfection, sterilization, and control of hospital waste. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (8th ed). Philadelphia: Elsevier Saunders; 2015. p. 3294-309.e4. Doi: 10.1016/B978-1-4557-4801-3.00301-5
Centers for Disease Control and Prevention. Steam Sterilization [Internet]. Atlanta (GA): CDC; 2023 Nov 28. [cited 2025 Feb 19]. Available from: https://www.cdc.gov/infection-control/hcp/disinfection-sterilization/steam-sterilization.html
Maps of India. Lifeline Express: a special train to deliver wellness and health [Internet]. [cited 2025 Feb 19]. Available from: https://www.mapsofindia.com/my-india/india/lifeline-express-a-special-train-to-deliver-wellness-and-health
Green Network. Dedikasi Dokter Lie Dharmawan bawa akses kesehatan gratis ke daerah terpencil [Internet]. [cited 2025 Mar 2]. Available from: https://greennetwork.id/unggulan/dedikasi-dokter-lie-dharmawan-bawa-akses-kesehatan-gratis-ke-daerah-terpencil/
Rural Doctors’ Association of South Australia Inc. Vale Dr Phil Tideman [Internet]. [cited 2025 Mar 2]. Available from: https://rdasa.com.au/SA/_SA/Vale-Dr-Phil-Tideman.aspx
Mohr NM, Ward MM, Swanson MB, Harland KK, Bell A, Shane DM, et al. Emergency department telemedicine is used for more severely injured rural trauma patients, but does not decrease transfer: a cohort study. Acad Emerg Med. 2017;24(2):177-85. Doi: 10.1111/acem.13120.
Fredericks C, Yon JR, Shersher D, Smego D, Bokhar F. Traumatic aorto-right ventricular fistula from stab wound. Trauma Emerg Care. 2017;2(1):1-3. Doi: 10.15761/TEC.1000104
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Marturia I. Aruperes, Wega Sukanto, Christha Z. Tamburian
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
COPYRIGHT
Authors who publish with this journal agree to the following terms:
Authors hold their copyright and grant this journal the privilege of first publication, with the work simultaneously licensed under a Creative Commons Attribution License that permits others to impart the work with an acknowledgment of the work's origin and initial publication by this journal.
Authors can enter into separate or additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (for example, post it to an institutional repository or publish it in a book), with an acknowledgment of its underlying publication in this journal.
Authors are permitted and encouraged to post their work online (for example, in institutional repositories or on their website) as it can lead to productive exchanges, as well as earlier and greater citation of the published work (See The Effect of Open Access).
