Auto Crashes and the Heart

When the victim of a head-on crash is trundled into the emergency room, the first place that the doctors look for serious injury is the head. Then they examine the chest for a broken rib that may have pierced a lung, and finally they look at the limbs. The heart and the "great vessels" adjoining it are usually not examined until much later--if at all. Yet in many cases there is a potentially fatal injury to the aorta, which, if promptly detected, can be corrected by today's advanced surgery.

Occupants of autos involved in smashups can be subjected to deceleration forces hundreds of times greater than that of gravity. In sudden deceleration, the sturdy chest wall usually suffers no injury unless it strikes something like the steering wheel; neither does the heart. But the aorta, the largest of the body's blood vessels, is not rigidly held in the area below its arch (see diagram). While the forward motion of the chest wall and heart halts suddenly when the car smashes to a stop, some parts of the aorta keep on moving forward for a fraction of a second longer.

That, in the opinion of the University of Rochester's Dr. Robert M. Greendyke, is long enough for the huge forces that result to cause the inner lining of the aorta to rupture and balloon out into an aneurysm, or to be virtually sheared off at a point such as its isthmus immediately below the arch.

Aortic Rupture. Greendyke's research confirmed this type of injury in one of every six persons killed in auto accidents. In most cases there were other injuries that would also have proved fatal. But in some, Greendyke is certain, early detection of the aortic rupture would have made life-saving surgery possible.

These conclusions are supported by the British Medical Journal, in which surgeons describe four auto-accident cases seen at Harefield Hospital in Middlesex. In two of them the aorta was ruptured; in one, the injury was to the mitral valve, and in one the septum (wall) between two of the heart's chambers was torn. Only a decade ago, there would have been little hope for the victims, but that is no longer true. In all four cases surgery was successful--including two instances in which the aorta was patched with a Dacron graft.

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