Cardiac contusion: Difference between revisions
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==Background== | ==Background== | ||
* | *Contusion is the most common type of [[blunt cardiac injury]] (60-100%) (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. | |||
*Autopsy shows patchy necrosis and hemorrhage of damaged areas of myocardium and is the "gold standard" for research<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> | |||
*Autopsy shows patchy necrosis and hemorrhage of damaged areas of myocardium. | |||
===Mechanism of injury=== | ===Mechanism of injury=== | ||
*MVC is common, but [[crush injuries]], [[CPR]] and others have also been described. | *MVC is common, but [[crush injuries]], [[CPR]] and others have also been described. | ||
*Can occur with decelerations from as little as less than 20mph<ref name="El-Chami" /> | *Can occur with decelerations from as little as less than 20mph<ref name="El-Chami" /> | ||
{{Background BCI}} | |||
==Clinical Features== | ==Clinical Features== | ||
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*[[Palpitations]] | *[[Palpitations]] | ||
*[[Tachycardia]] | *[[Tachycardia]] | ||
*[[Dyspnea]]/[[ | *[[Dyspnea]]/[[shortness of breath]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Thoracic trauma DDX}} | {{Thoracic trauma DDX}} | ||
== | ==Evaluation== | ||
''Diagnosis is difficult due to spectrum of clinical disease and lack of adequate test in the ED'' | ''Diagnosis is difficult due to spectrum of clinical disease and lack of adequate test in the ED'' | ||
*Physical exam | *Physical exam | ||
**Majority (75%) of | **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" /> | *Imaging<ref name="Sybrandy" /> | ||
**CXR and CT Chest are neither sensitive nor specific for cardiac contusion, but may show other blunt cardiac injury | **[[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 | **Echocardiography may be useful - contusion will show localized wall motion abnormality | ||
* | *[[ECG]] - may be normal or show non-specific abnormalities<ref name="Sybrandy" /> | ||
**most common abnormality in order (sinus tachycardia, PVCs, atrial fibrillation) | **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 | **81–95% of life threatening ventricular arrhythmias and acute cardiac failures occur within the first 24–48 hrs | ||
*Cardiac enzymes (Troponin, CK-MB)<ref name="Sybrandy" /> | *[[Cardiac enzymes]] (Troponin, CK-MB)<ref name="Sybrandy" /> | ||
**CK-MB is neither sensitive nor specific | **CK-MB is neither sensitive nor specific | ||
**Troponin is specific for cardiac injury, but not sensitive for cardiac contusion | **[[Troponin]] is specific for cardiac injury, but not sensitive for cardiac contusion | ||
==Management== | ==Management== | ||
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==Disposition== | ==Disposition== | ||
* | *Patients with mild injury, normal ECG, and negative Troponin can likely be discharged after period of observation<ref name="Sybrandy" /> | ||
*Admit to telemetry bed for: | *Admit to telemetry bed for: | ||
**Hemodynamic instability | **Hemodynamic instability | ||
**Abnormal [[ | **Abnormal [[ECG]] | ||
**Elevated troponin | **Elevated troponin | ||
==Prognosis== | ===Prognosis=== | ||
*Generally favorable prognosis | *Generally favorable prognosis | ||
*Even if | *Even if patient has minor wall motion abnormality, mild arrhythmia, etc, these usually resolve within 1 day<ref>Bock JS, Benitez RM. Blunt cardiac injury. Cardiol Clin. 2012 Nov;30(4):545-55. doi: 10.1016/j.ccl.2012.07.001.</ref> | ||
**Long-term sequelae are rare in hemodynamically stable patient without significant | **Long-term sequelae are rare in hemodynamically stable patient without significant ECG abnormality | ||
**Severe cardiac contusion may rarely lead to ventricular remodeling and aneurysm. | **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<ref>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.</ref> | |||
==See Also== | ==See Also== | ||
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<References/> | <References/> | ||
[[Category: | [[Category:Cardiology]] | ||
[[Category:Trauma]] | [[Category:Trauma]] |
Latest revision as of 20:58, 17 August 2019
Background
- Contusion is the most common type of blunt cardiac injury (60-100%) (Other sources cite lower figures of 8-76%[1][2])
- 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[1]
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[2]
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.[3]
- Commotio cordis is sudden cardiac arrest resulting from blunt chest trauma, in absence of underlying cardiac disease[4]
- Up to 20% of all MVC deaths are due to blunt cardiac injury
Clinical Features
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
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[5]
- Imaging[5]
- 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[5]
- 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)[5]
- CK-MB is neither sensitive nor specific
- Troponin is specific for cardiac injury, but not sensitive for cardiac contusion
Management
- Treatment is generally supportive and based on clinical presentation[5]
- Do NOT treat arrhythmias prophylactically (increased mortality!)
- Do NOT give thrombolytics for signs of myocardial infarction (increased mortality)
Disposition
- Patients with mild injury, normal ECG, and negative Troponin can likely be discharged after period of observation[5]
- Admit to telemetry bed for:
- Hemodynamic instability
- Abnormal ECG
- Elevated troponin
Prognosis
- Generally favorable prognosis
- Even if patient has minor wall motion abnormality, mild arrhythmia, etc, these usually resolve within 1 day[6]
- 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[7]
See Also
References
- ↑ 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.