title: Cardiomyopathy induced by sinus tachycardia in combat wounded: a case study.
abstract: Tachycardia induced cardiomyopathy is a potentially lethal cause of heart failure generally because of atrial tachycardia and less frequently ventricular tachycardia. We present two cases of Marines with severe traumatic blast injuries secondary to improvised explosive device attacks whose hospital courses included amputation, massive blood transfusions, and multiple surgeries. Both patients had prolonged sinus tachycardia averaging >110 beats per minute and developed depressed left ventricular function, which recovered when treated with β blockers. Sinus tachycardia is often considered a physiological response to stress, and the purpose of this manuscript is to describe the cardiac injury apparently related to a prolonged stress response. In addition, the literature does not clearly recommend controlling heart rates in trauma patients with persistent sinus tachycardia, but it is a therapeutic option that should be considered by providers.
authors.affiliation: Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134.
authors.forename: Michael
authors.initials: M
authors.lastname: Kavanaugh
authors.affiliation: Naval Hospital Jacksonville, 2080 Child Street, Jacksonville, FL 32214.
authors.forename: Jonathan
authors.initials: J
authors.lastname: McDivitt
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Andrew
authors.initials: A
authors.lastname: Philip
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Jerald W
authors.initials: JW
authors.lastname: Froehner
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: John
authors.initials: J
authors.lastname: Rotruck
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Brian
authors.initials: B
authors.lastname: Hemann
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Mark
authors.initials: M
authors.lastname: Haigney
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: John
authors.initials: J
authors.lastname: Atwood
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Joel Anthony
authors.initials: JA
authors.lastname: Nations
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D001753:Blast Injuries / Q000150:complications* / Q000628:therapy*; D009202:Cardiomyopathies / Q000188:drug therapy / Q000209:etiology*; D004452:Echocardiography; D006801:Humans; D008297:Male; D008889:Military Personnel; D009104:Multiple Trauma; D013318:Stroke Volume; D013616:Tachycardia, Sinus / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000319:Adrenergic beta-Antagonists