Cardiac contusion: Difference between revisions

Revision as of 16:50, 21 June 2016

Cardiac contusion is on the spectrum of Blunt cardiac injury (BCI), which ranges from mild contusion to cardiac rupture.^[1]
- Contusion is the most common of these, found in 60-100% of all blunt cardiac injury. (Other sources cite lower figures of 8-76%^[2]^[3])
- Range is due to lack of standardized diagnostic criteria.
Autopsy shows patchy necrosis and hemorrhage of damaged areas of myocardium and is the "gold standard" for research^[2]

Diagnosis is difficult due to spectrum of clinical disease and lack of adequate test in the ED

Physical exam
- Majority (75%) of patients will have evidence of chest wall trauma^[4]
Imaging^[4]
- CXR and CT Chest are neither sensitive nor specific for cardiac contusion, but may show other blunt cardiac injury
- Echocardiography may be useful - contusion will show localized wall motion abnormality
ECG - may be normal or show non-specific abnormalities^[4]
- most common abnormality in order (sinus tachycardia, PVCs, atrial fibrillation)
- 81–95% of life threatening ventricular arrhythmias and acute cardiac failures occur within the first 24–48 hrs
Cardiac enzymes (Troponin, CK-MB)^[4]
- CK-MB is neither sensitive nor specific
- Troponin is specific for cardiac injury, but not sensitive for cardiac contusion

Treatment is generally supportive and based on clinical presentation^[4]
Do NOT treat arrhythmias prophylactically (increased mortality!)
Do NOT give thrombolytics for signs of myocardial infarction (increased mortality)

Pts with mild injury, normal ECG, and negative Troponin can likely be discharged after period of observation^[4]
Admit to telemetry bed for:
- Hemodynamic instability
- Abnormal ECG
- Elevated troponin

Generally favorable prognosis
Even if pt has minor wall motion abnormality, mild arrhythmia, etc, these usually resolve within 1 day^[5]
- Long-term sequelae are rare in hemodynamically stable patient without significant ECG abnormality
- Severe cardiac contusion may rarely lead to ventricular remodeling and aneurysm
Short tele admit as 81-95% of ventricular dysrhythmias and cardiac failure within 1-2 days after trauma^[6]

↑ El-Menyar A, Al Thani H, Zarour A, Latifi R. Understanding traumatic blunt cardiac injury. Ann Card Anaesth. 2012 Oct-Dec;15(4):287-95. doi: 10.4103/0971-9784.101875.
↑ ^2.0 ^2.1 Emet M, Saritemur M, Altuntas B, et al. Dual-source computed tomography may define cardiac contusion in patients with blunt chest trauma in ED. Am J Emerg Med. 2015 Jun;33(6):865.e1-3. doi: 10.1016/j.ajem.2014.12.059.
↑ ^3.0 ^3.1 El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med. 2008 Aug;35(2):127-33.
↑ ^4.0 ^4.1 ^4.2 ^4.3 ^4.4 ^4.5 Sybrandy KC, Cramer MJM, Burgersdijk C. Diagnosing cardiac contusion: old wisdom and new insights. Heart. 2003;89(5):485-489.
↑ Bock JS, Benitez RM. Blunt cardiac injury. Cardiol Clin. 2012 Nov;30(4):545-55. doi: 10.1016/j.ccl.2012.07.001.
↑ K C Sybrandy, M J M Cramer, and C Burgersdijk. Diagnosing cardiac contusion: old wisdom and new insights. Heart. 2003 May; 89(5): 485–489.

Authors:

@@ Line 21: / Line 21: @@
 ''Diagnosis is difficult due to spectrum of clinical disease and lack of adequate test in the ED''
 *Physical exam
-**Majority (75%) of pts will have evidence of chest wall trauma<ref name="Sybrandy">Sybrandy KC, Cramer MJM, Burgersdijk C. Diagnosing cardiac contusion: old wisdom and new insights. Heart. 2003;89(5):485-489.</ref>
+**Majority (75%) of patients will have evidence of chest wall trauma<ref name="Sybrandy">Sybrandy KC, Cramer MJM, Burgersdijk C. Diagnosing cardiac contusion: old wisdom and new insights. Heart. 2003;89(5):485-489.</ref>
 *Imaging<ref name="Sybrandy" />
 **[[CXR]] and CT Chest are neither sensitive nor specific for cardiac contusion, but may show other blunt cardiac injury