Absence of hemodynamic and ECG changes in a patient with traumatic left ventricular injury and puncture of the left anterior descending branch

Patients with penetrating cardiac injury usually present with cardiac tampo nade and shock upon hospital arrival. However, absence of hemodynamic depre ssion does not exclude a potentially fatal injury of the heart: This articl e reports on a patient who developed neither hemodynamic depression nor ECG changes for several hours, despite two left ventricular lacerations with p uncture of the LAD. Echocardiography is advocated as the diagnostic tool of choice, and it is emphasized that no penetrating objects should be removed from the wound before surgical access to the hl art is established, as thi s may result in the sudden development of cardiac tamponade.