Cardiac contusion

Background

• Cardiac contusion is on the spectrum of Blunt cardiac injury (BCI), which ranges from mild contusion to cardiac rupture.
  • Contusion is the most common of these, found in 60-100% of all blunt cardiac injury. (Other sources cite lower figures of 8-76%)
  • 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
• Autopsy shows patchy necrosis and hemorrhage of damaged areas of myocardium.

Clinical Features

• Chest pain
• Palpitations
• Tachycardia
• Dyspnea/SOB

Differential Diagnosis

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Diagnosis

• Physical
  • New murmur
• EKG
  • most common abnormality in order
    • Sinus tachy
    • PVCs
    • A. fib
  • Dysrythmia can be delayed for up to 12 hours
• Do NOT need enzymes but can help dx
  • Positive Trop
• Echo
  • Can aid in further determining the extent of damage

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