{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T08:50:04Z","timestamp":1758444604925,"version":"3.44.0"},"reference-count":5,"publisher":"BMJ","issue":"20","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[2018,5,22]]},"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec id=\"s1\">\n                  <jats:title>Clinical\u00a0introduction<\/jats:title>\n                  <jats:p>A man in his late 40s presented with severe chest pain and progressive dyspnoea after hitting a tree at high speed during a bike ride in the woods. On admission, the patient appeared agitated, pale and sweaty. Core temperature was 35.5\u00b0C, respiratory rate 35\/min and blood pressure 90\/50\u2009mm\u00a0Hg with a regular pulse at 110 beats\/min. Physical examination revealed multiple sternal bruises, distended jugular veins and muffled heart sounds (figure 1A). Lactate level was 4.4\u2009mmol\/L (normal\u00a0&lt;2.0\u2009mmol\/L) and high-sensitivity cardiac troponin T 0.142 mcg\/L (normal\u00a0&lt;0.005\u2009mcg\/L). An ECG and a total body CT scan were performed (figure 1B,C).<\/jats:p>\n                  <jats:fig id=\"F1\" position=\"float\" orientation=\"portrait\">\n                     <jats:label>Figure 1<\/jats:label>\n                     <jats:caption>\n                        <jats:p>(A) Multiple sternal bruises. (B) ECG on admission. (C) Thoracic CT.<\/jats:p>\n                     <\/jats:caption>\n                     <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"heartjnl-2018-313504-f1\" position=\"float\" orientation=\"portrait\"\/>\n                  <\/jats:fig>\n               <\/jats:sec>\n               <jats:sec id=\"s2\">\n                  <jats:title>Question:\u00a0 What is the most likely diagnosis?<\/jats:title>\n                  <jats:list list-type=\"alpha-upper\">\n                     <jats:list-item>\n                        <jats:p>Inferior myocardial infarction with right ventricular involvement.<\/jats:p>\n                     <\/jats:list-item>\n                     <jats:list-item>\n                        <jats:p>Cardiac contusion with tamponade.<\/jats:p>\n                     <\/jats:list-item>\n                     <jats:list-item>\n                        <jats:p>Commotio cordis.<\/jats:p>\n                     <\/jats:list-item>\n                     <jats:list-item>\n                        <jats:p>Aortic laceration.<\/jats:p>\n                     <\/jats:list-item>\n                  <\/jats:list>\n               <\/jats:sec>","DOI":"10.1136\/heartjnl-2018-313504","type":"journal-article","created":{"date-parts":[[2018,7,20]],"date-time":"2018-07-20T12:25:10Z","timestamp":1532089510000},"page":"1706-1706","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["A shocking bike accident"],"prefix":"10.1136","volume":"104","author":[{"given":"Jerrold","family":"Spapen","sequence":"first","affiliation":[{"name":"Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stijn","family":"Lochy","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium"},{"name":"Department of Intensive Care Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Michiels","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,20]]},"reference":[{"doi-asserted-by":"publisher","key":"2025092001593642000_104.20.1706.1","DOI":"10.1136\/heart.89.5.485"},{"doi-asserted-by":"publisher","key":"2025092001593642000_104.20.1706.2","DOI":"10.1136\/emj.2004.015339"},{"key":"2025092001593642000_104.20.1706.3","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1056\/NEJMra0910111","article-title":"Estes NA 3rd. Commotio cordis","volume":"11","author":"Maron","year":"2010","journal-title":"N Engl J Med"},{"key":"2025092001593642000_104.20.1706.4","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.ijcard.2015.10.029","article-title":"Trauma induced myocardial infarction","volume":"203","author":"Lolay","year":"2016","journal-title":"Int J Cardiol"},{"key":"2025092001593642000_104.20.1706.5","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1186\/s13054-017-1908-6","article-title":"Detailing the cardiovascular profile in shock patients","volume":"21","author":"De Backer","year":"2017","journal-title":"Crit Care"}],"container-title":["Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/heartjnl-2018-313504","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,20]],"date-time":"2025-09-20T08:59:44Z","timestamp":1758358784000},"score":1,"resource":{"primary":{"URL":"https:\/\/heart.bmj.com\/lookup\/doi\/10.1136\/heartjnl-2018-313504"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,20]]},"references-count":5,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2018,9,27]]},"published-print":{"date-parts":[[2018,10]]}},"alternative-id":["10.1136\/heartjnl-2018-313504"],"URL":"https:\/\/doi.org\/10.1136\/heartjnl-2018-313504","relation":{},"ISSN":["1355-6037","1468-201X"],"issn-type":[{"type":"print","value":"1355-6037"},{"type":"electronic","value":"1468-201X"}],"subject":[],"published":{"date-parts":[[2018,7,20]]}}}