Trauma of the Heart*

Trauma of the heart may result (1 ) from wounds and direct violence and (2) from strain of effort. Wounds of the heart are not common in this country, and will be excluded from this discussion. Direct violence to the chest wall may rupture the heart muscle, causing death, or may cause death without obviotis heart injury; or it may give rise to the following clinical conditions: (I) pericarditis; (2) angina of effort ; (3) a disorder of rhythm: (4) lesion of a valve; (5) contusion of the heart muscle. Strain may result in: (a) a disorder of rhythmb (b) lesion of a valve ; (c) primary cardiac overstrain. Spontaneous rupture of the heart muscle is. of course, the result of coronary disease. Goodall and Weir (1927) record eighteen cases, but in only four was there evidence of emotion or strain. Such an event can hardly be included in trauma of the heart. Genuine cases of heart disease the result of injury or sudden strain are not very common. There is nothing distinctive about the physical signs. For a diagnosis we depend upon an accurate history and, if obtainable, previous personal medical knowledge of the patient. Many doctors can quote one or two cases in which they were convinced that trauma produced disease of the heart, or that it so aggravated the condition of a heart already diseased that the whole life-history was changed. A traumatic heart lesion shown at a clinical meeting will provoke criticism, because the physical signs will be similar to those met with in disease due to natural causes, and it must be demonstrated that the condition before, at the time of, and immediately after the trauma has been correctly assessed. Nevertheless, I believe that at the present time more cases of heart disability the result of trauma are overlooked than are diagnosed by mistake. During the last thirty years I have made brief notes of twenty cases in which trauma of the heart must be considered seriously. Twelve have been the result of direct violence and eight the result of strain, although in three of them both forms of trauma may have been acting together. One man with a traumatic lesion of the mitral valve was under observation for seventeen years until he died, when the trauma was confirmed at necropsy. In the twelve cases of direct violence it is safe to presume that the heart was normal before the injurv. In three of the eight cases due to strain it is presumed that the heart was already diseased, but the strain altered the whole life-history. A reasonable definition of a normal heart would be: one that is efficient for the age and usual activities of an individual, and which would show no