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this paper refers to a case of clinical forensic evaluation, in terms of labour law, the patient evoking the existence of cardiac sequelae supervening head trauma, due to a fall from a height. Beside a brief reflexion on this pathological entity, the authors also pretend to illustrate the importance of an accurate analysis of all available data, from patient interview to clinical documentation, in order to establish the causal nexus. Introduction and objectives A wide variety of cardiac changes following acute head injury have been described, mainly concerning heart rate and rhythm, traducing it selves by eKG abnormalities, and are believed to be due to autonomic nervous system dysfunction (table 1), prevailing the sympathetic system activation, in the context of the acute stress response to trauma, with rising of circulating cathecolamine levels. therefore, taquiarrythmias are more frequent than bradiarrythmias, the most commonly described being the supraventricular tachycardia. these changes have been reported even after minor head injuries and are usually reversible, showing a parallel course within the patient’ neurological status. In the present case, the main question to answer was whether the accident was due to atrio-ventricular blockade (as evidenced by the eKG performed at the moment of medical emergency assistance), followed by syncope, or if the accident itself, resulting in head trauma, caused the atrio-ventricular blockade and could therefore be responsible for the present clinical condition of the patient.

Fall from a height with head trauma: due to or complicated by cardiac dysfunction?: one case study