pyrophosphate and Electric-Injuries

In the patient with cardiac trauma, radionuclide imaging may provide important information about cardiac mechanical function, vascular anatomy and integrity, myocardial perfusion, and myocardial metabolism. Studies require only minimal patient cooperation, can be performed relatively rapidly and often at the bedside, and may be repeated at frequent intervals for serial evaluations. These studies provide valuable adjunctive knowledge when selected and interpreted with knowledge of the mechanism of injury, timing of the examination relative to the time of injury, and most likely differential diagnoses.

Topics: Aged; Contusions; Diagnosis, Differential; Diphosphates; Electric Injuries; Female; Heart Aneurysm; Heart Injuries; Heart Neoplasms; Humans; Male; Methods; Middle Aged; Myocardial Infarction; Myxoma; Pericardial Effusion; Technetium; Technetium Tc 99m Pyrophosphate; Tomography, Emission-Computed; Tricuspid Valve Insufficiency; Wounds, Gunshot

Multiple defibrillations by the automatic implantable cardioverter/defibrillator (AICD) have been reported to result in localized epicardial damage. No data exist, however, regarding whether this damage can be detected in the clinical setting or whether it interferes with the detection of true myocardial infarction. Forty-nine patients who received defibrillations by patch electrodes were studied prospectively. We attempted to document the presence of myocardial injury with the following three commonly used modalities for the detection of myocardial infarction: serial electrocardiographic changes, serial creatine phosphokinase (CPK) and CPK-MB release, and technetium 99m pyrophosphate scanning. Fifteen patients received defibrillations by AICD patches at the time of AICD generator replacement. Nine patients received defibrillations at the time of new AICD lead placement. The average total energy delivered was 85 +/- 29 J. None of these patients had detectable myocardial injury. Ten patients had defibrillations by the AICD patches at the time of bypass operation. One patient in this group developed acute myocardial infarction in the inferior wall after posterior descending coronary bypass operation, as detected by electrocardiogram, 99mTc pyrophosphate scanning, and CPK-MB analysis. Fifteen patients were evaluated for spontaneous AICD discharges. Thirteen had a maximum of five consecutive shocks, and cumulative energy delivered was not greater than 330 J. None of these patients had detectable injury. Two patients had CPK-MB release of 15.3% and 7.5%, respectively. One of these patients had a positive 99mTc pyrophosphate scan. These two patients received 12 and 17 rapid and consecutive AICD discharges, respectively, with cumulative delivered energy of 360 and 510 J, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Aged; Creatine Kinase; Diphosphates; Electric Countershock; Electric Injuries; Electrocardiography; Female; Heart Injuries; Humans; Isoenzymes; Male; Middle Aged; Prospective Studies; Prostheses and Implants; Technetium; Technetium Tc 99m Pyrophosphate

An adolescent boy sustained low voltage electrical injury to his extremities when he inadvertently touched a low tension (440 volts) wire with a metal tube. Early in his hospital course, he was evaluated with Tc-99m pyrophosphate whole body scanning for the extent of his injuries. The scintigraphic findings correlated well with his subsequent clinical course.

Topics: Child; Diphosphates; Electric Injuries; Extremities; Humans; Male; Radionuclide Imaging; Technetium; Technetium Tc 99m Pyrophosphate