Overview :

Turk and Tsokos reviewed autopsy findings in patients who had fallen from height. Blunt cardiac injury may be overshadowed by other traumatic injuries yet can be fatal if not diagnosed and treated early. The authors are from the University of Hamburg in Germany.

Types of blunt cardiac injuries that occurred:

(1) pericardial tears (most common)

(2) epicardial hematoma following epicardial tear near the junction of the inferior vena cava and right atrium

(3) transmural tear in the right atrium

(4) transmural tear in the left atrium

(5) endocardial terars in the atria

(6) transmural tears of the right ventricle

(7) transmural left ventricular tears

(8) rupture of the right coronary artery

(9) rupture of a papillary muscle

Cardiac injuries were not found with falls <= 6 meters. The risk of cardiac injury increased with the height fallen above 6 feet, with very severe injuries occurring with falls > 25 meters.

Risk factors for blunt cardiac injury:

(1) fall from height > 6 meters

(2) sternal fracture, especially if multiple

(3) abnormal cardiac examination

(4) abnormal ECG

Other frequent findings:

(1) head trauma

(2) multiple trauma to bones, lungs, abdominal viscera, and blood vessels

A patient with one or more risk factors for cardiac injury should be triaged to a center capable of performing cardiopulmonary bypass. A thorough cardiologic examination should be performed with explorative thoracotomy considered if abnormalities are found or severe cardiac injuries are suspected.

Turk EE, Tsokos M. Blunt cardiac trauma caused by fatal falls from height: An autopsy-based assessment of the injury pattern. J Trauma. 2004; 57: 301-304.