- Contusion is the most common type of blunt cardiac injury (60-100%) (Other sources cite lower figures of 8-76%)
- 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
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
Blunt cardiac injury
- A spectrum of disease due to blunt trauma to the chest wall
- Ranges from cardiac contusion to infarction to cardiac rupture and death.
- Commotio cordis is sudden cardiac arrest resulting from blunt chest trauma, in absence of underlying cardiac disease
- Up to 20% of all MVC deaths are due to blunt cardiac injury
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
- 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
- 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)
- 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
- Do NOT treat arrhythmias prophylactically (increased mortality!)
- Do NOT give thrombolytics for signs of myocardial infarction (increased mortality)
- Patients with mild injury, normal ECG, and negative Troponin can likely be discharged after period of observation
- Admit to telemetry bed for:
- Hemodynamic instability
- Abnormal ECG
- Elevated troponin
- Generally favorable prognosis
- Even if patient has minor wall motion abnormality, mild arrhythmia, etc, these usually resolve within 1 day
- 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
- ↑ 1.0 1.1 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.
- ↑ 2.0 2.1 El-Chami MF, Nicholson W, Helmy T. Blunt cardiac trauma. J Emerg Med. 2008 Aug;35(2):127-33.
- ↑ 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.
- ↑ Yousef R, Carr JA. Blunt cardiac trauma: a review of the current knowledge and management. Ann Thorac Surg. 2014 Sep;98(3):1134-40. doi: 10.1016/j.athoracsur.2014.04.043.
- ↑ 5.0 5.1 5.2 5.3 5.4 5.5 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.