From the Guidelines
Lethal diamond is not a medical term, but based on the provided evidence, it seems to be related to a condition known as Congenitally Corrected Transposition of the Great Arteries (CCTGA), which is a rare congenital heart defect. The term "lethal diamond" is not found in the provided medical evidence, but it is possible that it refers to the complex and potentially life-threatening nature of CCTGA.
- Key points to consider in the management of CCTGA include:
- Associated lesions such as dextrocardia, VSD, (sub-)pulmonary stenosis, and Ebstein-like malformation of the left-sided tricuspid valve 1
- The sub-aortic RV is prone to dysfunction and regurgitation of its tricuspid valve 1
- CMR is useful for quantification of systemic RV size and function, and administration of gadolinium contrast can help identify fibrotic myocardium 1
- Symptomatic adults with CCTGA and severe TR with no more than mildly depressed systemic ventricular function should be evaluated for tricuspid valve replacement 1
- Tricuspid valve replacement is preferred to tricuspid repair in the adult CCTGA population, as TR is often due to a dysplastic tricuspid valve and has been shown to be an independent predictor of death in CCTGA patients 1
- Systemic RV dysfunction is often attributable to longstanding TR, and efforts should be made to relieve the TR before worsening dysfunction 1
- Conduction abnormalities are common, and the prevalence of spontaneous complete heart block increases with age 1
- PS, ASD, and VSD are common associated cardiac anomalies, and 70-90% of patients with CCTGA have a dysplastic or Ebstein-like malformation of the tricuspid valve 1
- The clinical course of adults with CCTGA often depends on the presence and severity of associated cardiac anomalies, which will often have required pediatric intervention 1
- Rarely, CCTGA may be first diagnosed in adulthood, particularly if patients do not have associated cardiac lesions 1
- The natural history and clinical presentation are usually determined by the associated cardiac malformations, and patients with isolated ccTGA may have no haemodynamic consequences in childhood and early adulthood 1
- Systemic right (subaortic) ventricular failure and/or severe systemic AV valve regurgitation may cause dyspnoea and exercise intolerance in the fourth or fifth decade 1
- A mismatch between myocardial blood supply and workload of the systemic (subaortic) ventricle may contribute to heart failure 1 Based on the most recent and highest quality study, the management of CCTGA should focus on early detection and treatment of associated cardiac anomalies, as well as close monitoring of systemic RV function and tricuspid valve regurgitation 1.
From the Research
Lethal Diamond Overview
- The term "lethal diamond" has been coined to underscore the importance of calcium in trauma mortality, in addition to the traditional "lethal triad" of hypothermia, acidosis, and coagulopathy 2.
- The lethal diamond is a concept that recognizes the role of hypocalcemia in trauma-induced coagulopathy and mortality.
Comparison of Lethal Triad and Lethal Diamond
- A study compared the lethal triad and lethal diamond in severe trauma patients and found no significant difference in their association with 24-h mortality 3.
- The study found that the strength of the association with 24-h mortality was similar between the lethal triad and the lethal diamond, with Cramer's V values of 0.29 and 0.28, respectively 3.
- The results of the study raise questions about the independent role of hypocalcemia in early mortality 3.
Clinical Implications
- The lethal diamond concept highlights the importance of considering hypocalcemia in the management of trauma patients 2.
- However, the evidence supporting the addition of hypocalcemia to the lethal triad is limited, and further research is needed to fully understand its role in trauma mortality 3.
- Activated charcoal may be considered as a treatment option in cases of overdose, but its effectiveness is still debated 4, 5.