1) Blunt force injuries to the heart can occur from fractured ribs compressing the heart or from forceful impacts against the chest like steering wheel impacts in car accidents. Stab wounds are also dangerous as the right ventricle is more likely to be pierced due to its position, leading to rapid blood loss. 2) Cardiac tamponade is a medical emergency caused by fluid building up around the heart from injuries like stab wounds or blunt force trauma. It presents with low blood pressure, increased central venous pressure, and muffled heart sounds. 3) Commotio cordis refers to sudden cardiac death from a blunt chest impact, usually seen in young athletes, when the impact occurs during a vulnerable

1. Traumatic heart and aortic
injuries
Dr M Balaji Singh
Professor of Forensic Medicine
ACS Medical college & Hospital, Chennai.
Courtesy; Dr Gautam Biswas.

2. Blunt force injuries
• Cardiac contusions or puncture wounds may
occur due to fractured ribs or compression
against spine from behind.
• Common in vehicular accidents
- By primary impact injuries
- Steering wheel impact
• Assault by blunt objects
• Fall from height on projected objects

3. Stab wounds of the heart are dangerous.
-If the left ventricle is pierced, the thickness of the
muscle wall may restrict the bleeding, allowing time
for surgical treatment.
-A stab of the right ventricle is more rapidly fatal.
-The right ventricle is more likely to be wounded, as it
exposes its widest area towards the front of the chest

4. fatal, blood escaping through
the wound to cause
hemopericardium and cardiac
tamponade.
-Even 150 ml (average 400–
500 ml) of blood can cause
death by increasing
intrapericardial pressure and
producing mechanical
interference with ventricular
contractility
Stab injury to the heart………

5. Cardiac tamponade presents with three signs (Beck’s
triad).
1. low arterial blood pressure,
2. increased central venous pressure
3. indistinct heart sounds.
-Hypotension occurs due to decreased stroke volume,
-jugular-venous distension due to impaired venous
return to the heart,
- muffled heart sounds due to fluid inside the
pericardium
Cardiac tamponade

6. - It refers to sudden cardiac death
- following a blunt trauma to the chest.
- It is often associated with sports and in
young athletes
Cardiac concussion or commotio cordis
Mechanism: when the impact occurs at an
electrically vulnerable phase of the cardiac cycle
(during early ventricular repolarization (15–30
milliseconds before the peak of the T wave) -
commotio cordis

9. The common sites - in order of diminishing
frequency are:
right auricle,
right ventricle,
left auricle,
ventricular septum and valves.
„non traumatic The only natural cause of rupture of
the heart is softening or thinning by infarction,
which invariably occurs in the left ventricle
traumatic cardiac rupture

10. Caused by -direct violence to the chest
-by compression of the thorax,
Eg: driver is forcibly thrown against the steering wheel.
Cardiac contusions - seen on the anterior surface of
either ventricle or the inter ventricular septum.
Recent cardiac contusions are dark-red, hemorrhagic
areas which are sub epicardial.
„
Contusions and lacerations of the heart

11. -The commonest pincer lesion is a contusion of the
right atrium at the entrance of the inferior vena
cava.
-sudden death, several days after the injury.
„
compression injuries heart

12. -Contrecoup contusions of the heart are seen over
the posterior wall of the left ventricle.
seen in traffic accidents in which the driver is thrown
forward against the steering wheel and the heart is
compressed against the vertebrae.
This will cause sudden death due to
- ventricular fibrillation,
death after few hours or days due to
- progressive circulatory failure
-
compression injuries heart........

13. Intra thoracic vessels
• injured because of sudden deceleration
- automobile collision,
- fall from height
- air crash.
• Disparity between the speeds of a fixed and a
mobile portion of the involved vessels is the
usual mechanism of production of injuries,

14. heart is a freely hanging apple to the
arch of aorta
Tear at arch of aorta - by fall
from height on feet
Point of
tear
Fixed
part

15. Mechanism - exsanguination
• Thoracic aorta- a classical example.
• aortic isthmus, distal to the origin of the left subclavian
artery - is fixed part , but proximal to that ,i.e. arch of aorta
is free part
• By fall from height , at the moment feet touching the land
the fixed portion of great vessel coming to an abrupt halt,
whereas mobile segment continues on its path due to pull
of the heart . Thus, shearing force causes tear of the vessel.
• So the aorta circumferentially transected at the junction of
free part and fixed part
• death occurs from exsanguination ( loss of blood to a
degree sufficient to cause death).