title: The cardiac pendulum: blunt rupture of the pericardium with strangulation of the heart.
abstract: BACKGROUND
  Blunt injury of the pericardium with strangulation of the heart is a rare clinical injury.
  
  
  METHODS
  We conducted a review of clinical records and performed prospective collection of forensic data from a large urban medical examiner's office.
  
  
  RESULTS
  Ten cases of blunt injury to the pericardium were identified. All were secondary to blunt trauma. Nine of the 10 cases had associated chest wall injuries and 5 of the 10 cases had cardiac strangulation.
  
  
  CONCLUSIONS
  Pericardial lacerations are common findings at autopsy. Clinically, those that survive to the hospital have a confusing presentation. They are often diagnosed during emergent thoracotomy for hemodynamic instability. Hemodynamic deterioration associated with change in patient position may be a clue to cardiac strangulation.
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA. mwall@bcm.tmc.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wall
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Mattox
authors.forename: Dwayne A
authors.initials: DA
authors.lastname: Wolf
mesh_terms: D000058:Accidental Falls; D000063:Accidents, Traffic; D000328:Adult; D000368:Aged; D001344:Autopsy; D005260:Female; D006335:Heart Injuries / Q000453:epidemiology*; D006341:Heart Rupture / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000293:injuries*; D013781:Texas / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000453:epidemiology*