Cardiac injury from blunt trauma
- Eric Legome, MD
Eric Legome, MD
- Professor of Clinical Emergency Medicine
- SUNY Downstate School of Medicine
- Chief of Emergency Medicine
- Kings Count Hospital, Brooklyn
- Howard Kadish, MD, MBA
Howard Kadish, MD, MBA
- Professor of Pediatrics
- Division Chief, Pediatric Emergency Medicine
- University of Utah School of Medicine
- Section Editors
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Director, Division of Pediatric Emergency Medicine
- Associate Professor of Emergency Medicine and Pediatrics (Clinical)
- NYU School of Medicine
- Deputy Editor
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
Blunt cardiac injury (BCI) encompasses a spectrum of pathology ranging from clinically silent, transient arrhythmias to deadly cardiac wall rupture. The most common form is "cardiac contusion" (ie, injury to the myocardium), which remains the subject of considerable debate. The absence of a clear definition and accepted gold standard for testing makes the diagnosis of cardiac contusion difficult. Important considerations in blunt cardiac trauma include arrhythmia, cardiac wall motion abnormalities, possibly progressing to cardiogenic shock, and rupture of valves, the septum, or a ventricular, atrial, or septal wall [1,2].
The evaluation and management of cardiac injuries sustained in adults from blunt thoracic trauma will be reviewed here. Other injuries from blunt trauma and injuries in children are discussed separately. (See "Initial evaluation and management of blunt thoracic trauma in adults" and "Initial evaluation and stabilization of children with thoracic trauma".)
EPIDEMIOLOGY, DEFINITIONS, AND SCORING
The incidence of blunt cardiac injury (BCI) is unknown, and estimates vary widely. Of diagnosed BCIs, "myocardial contusion" or "cardiac contusion" is most common. However, each of these terms has been used to refer to a range of cardiac injuries. The absence of clear diagnostic criteria and reliable diagnostic tests makes reporting difficult. Suggestive symptoms may be unrelated to BCI, while some injuries may be clinically asymptomatic. Furthermore, some criteria used to define significant BCI, such as arrhythmias, may be due to the effects of multiple trauma in a susceptible patient (eg, patient with preexisting heart disease). Other diagnostic criteria, such as an elevated troponin, may be seen in major trauma remote from the chest . (See 'Cardiac biomarkers' below.)
Due to the ambiguity surrounding the terms "myocardial contusion" and "cardiac contusion", we prefer to describe BCIs in terms of specific injuries (eg, septal rupture, myocardial infarction) or cardiac dysfunction (eg, diminished contractility in the absence of arrhythmia or hemorrhage). (See 'Types of injury' below.)
Cardiac rupture is the most devastating BCI. Most patients who sustain rupture of a heart chamber do not reach the emergency department alive. Chamber rupture is described primarily in autopsy series [4,5]. (See 'Anatomy and mechanism of injury' below.)
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- EPIDEMIOLOGY, DEFINITIONS, AND SCORING
- ANATOMY AND MECHANISM OF INJURY
- PREHOSPITAL MANAGEMENT
- CLINICAL FEATURES
- Types of injury
- Initial stabilization
- Diagnostic tests
- - Electrocardiogram
- - Echocardiogram
- - Cardiac biomarkers
- DIAGNOSTIC APPROACH
- Myocardial or cardiac contusion
- Valve, septum, or ventricular wall injury
- Acute coronary syndrome
- Cardiac dysfunction
- PEDIATRIC CONSIDERATIONS
- Presentation, diagnosis, and management
- SUMMARY AND RECOMMENDATIONS