Closed Cardiac Trauma: Literature Review and Case Series of Combat Trauma

The aim. Analysis of the causes, diagnosis and treatment methods of closed heart injuries through the examples of literary sources and our own clinical cases. Russia’s full-scale invasion of Ukraine led to massive hostilities. This war not only changed the geopolitical situation in Europe, but also presented new challenges to the medical community, particularly in the field of military medicine. Among many types of combat injuries, heart injury, which can be both open and closed, requires special attention. Although both types of injuries are life-threatening, the closed heart injury becomes more relevant in the conditions of modern warfare. A closed heart injury often accompanies any chest injuries, has a hidden course, and its real prevalence exceeds the number of diagnosed cases. Among the closed injuries of the heart, concussion is accompanied by the least damage to the structures and the mildest consequences, while heart rupture has an intensive clinical manifestation, an extremely difficult course, and often fatal consequences. Most often, a heart bruise occurs with a chest injury. The proper diagnosis of heart bruise at the pre-hospital stage is accompanied by difficulties. They are associated with the conditions of the history taking and physical examination of the wounded person. The mentioned conditions include the lack of time, impaired consciousness of the victim (for example, when combined with a craniocerebral injury), lack of additional laboratory and instrumental diagnostic methods as well as different levels of training of medical personnel. The article presents a detailed description of the types of closed heart trauma, clinical, laboratory and instrumental characteristics of each type, as well as a generalized scheme of treatment tactics. In addition, three clinical cases of heart bruise with different severity of clinical manifestation are provided. Conclusion. In the conditions of modern warfare, a closed heart injury is more relevant than an open type of the combat heart trauma. This requires military and civilian physicians to pay more attention to the possible presence of this type of injury, to improve diagnostics and treatment approaches, and to develop effective field care protocols.