Proposed mechanism:
(1) damage to a coronary artery with thrombosis and subsequent infarction
(2) blast wave from impact
(3) congenital defect in the ventricular septum
The onset may be immediate or delayed.
The significance of the injury depends on:
(1) the size of the left-to-right shunt
(2) the severity of pulmonary hypertension
(3) other cardiothoracic injuries
Clinical and laboratory findings may include:
(1) cardiogenic shock
(2) holosystolic murmur
(3) exertional dyspnea
(4) chest pain
(5) abnormal ECG
(6) elevated serum troponin
Sometimes the findings are nonspecific and diagnosis is delayed.
Imaging studies such as transesophageal or transthoracic echocardiography are important in confirming the diagnosis and planning a therapeutic strategy.
Accompanying complications may include:
(1) mitral or tricuspid valve insufficiency due to rupture of papillary muscles
(2) hemopericardium
(3) damage to the free wall of the left ventricle
(4) tear in the aorta
