Cardiac contusion: Difference between revisions

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==Background==
==Background==
*Cardiac contusion is on the spectrum of [[Blunt cardiac injury]] (BCI), which ranges from mild contusion to cardiac rupture.<ref name="El-Menyar">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.</ref>
*Cardiac contusion is on the spectrum of [[Blunt cardiac injury]] (BCI), which ranges from mild contusion to cardiac rupture.<ref name="El-Menyar">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.</ref>
**Contusion is the most common of these, found in 60-100% of all blunt cardiac injury. (Other sources cite lower figures of 8-76%<ref name="El-Chami">El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med. 2008 Aug;35(2):127-33.</ref>)
**Contusion is the most common of these, found in 60-100% of all blunt cardiac injury. (Other sources cite lower figures of 8-76%<ref name="Emet" /><ref name="El-Chami">El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med. 2008 Aug;35(2):127-33.</ref>)
**Range is due to lack of standardized diagnostic criteria.
**Range is due to lack of standardized diagnostic criteria.
*Mechanism of injury
*Mechanism of injury
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==Diagnosis==
==Diagnosis==
*Physical
''Diagnosis is difficult due to spectrum of clinical disease and lack of adequate test in the ED''<br>
**New murmur
Autopsy is the standard diagnostic modality<ref name="Emet">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.</ref>
*EKG
 
**most common abnormality in order
*Physical exam
***Sinus tachy
**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>
***PVCs
*Imaging<ref name="Sybrandy" />
***A. fib
**CXR and CT Chest are neither sensitive nor specific for cardiac contusion, but may show other blunt cardiac injury
**Dysrythmia can be delayed for up to 12 hours
**Echocardiography may be useful - contusion will show localized wall motion abnormality
*Do NOT need enzymes but can help dx
*EKG - may be normal or show non-specific abnormalities<ref name="Sybrandy" />
**Positive Trop
**most common abnormality in order (sinus tachycardia, PVCs, atrial fibrillation)
*Echo
**Dysrythmia can be delayed for hours, so serial EKGs are recommended
**Can aid in further determining the extent of damage
*Cardiac enzymes (Troponin, CK-MB)<ref name="Sybrandy" />
**CK-MB is neither sensitive nor specific
**Troponin is specific for cardiac injury, but not sensitive for cardiac contusion


==Treatment==
==Treatment==

Revision as of 04:24, 25 July 2015

Background

  • 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.
  • Mechanism of injury
    • MVC is common, but crush injuries, CPR and others have also been described.
    • Can occur with decelerations from as little as less than 20mph[3]
  • Autopsy shows patchy necrosis and hemorrhage of damaged areas of myocardium.

Clinical Features

  • Chest pain
  • Palpitations
  • Tachycardia
  • Dyspnea/SOB

Differential Diagnosis

Thoracic Trauma

Diagnosis

Diagnosis is difficult due to spectrum of clinical disease and lack of adequate test in the ED
Autopsy is the standard diagnostic modality[2]

  • Physical exam
    • Majority (75%) of pts 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
  • EKG - may be normal or show non-specific abnormalities[4]
    • most common abnormality in order (sinus tachycardia, PVCs, atrial fibrillation)
    • Dysrythmia can be delayed for hours, so serial EKGs are recommended
  • 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

  • Treat arrhythmia prn
    • Do NOT treat prophylactically (increased mortality!)
  • NO thrombolytics for AMI (increased mortality)

Disposition

Observation for 6 hours

  • Admit to telemetry bed for:
    • Abnormal physical exam
    • Abnormal EKG
    • Hypotension

See Also

Thoracic Trauma

References

  1. ↑ 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. ↑ 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. ↑ 3.0 3.1 El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med. 2008 Aug;35(2):127-33.
  4. ↑ 4.0 4.1 4.2 4.3 Sybrandy KC, Cramer MJM, Burgersdijk C. Diagnosing cardiac contusion: old wisdom and new insights. Heart. 2003;89(5):485-489.
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