Cardiac Contusions

Abstract

Cardiac contusion has been one of the most discussed topics in the trauma community. The discussions are centered around appropriate nomenclature, screening mechanisms, diagnostic modalities, and ultimately management principles. Controversy over nomenclature exists because cardiac contusion has been used to describe an array of injuries ranging from a transient arrhythmia to free rupture of the myocardial wall. The mainstays of screening have been electrocardiograms and cardiac isoenzymes. Although there is a substantial body of literature, few other screening or diagnostic modalities have been widely accepted. Echocardiography has gained favor as a confirmatory test and to determine presence or extinct of structural damage. Management has traditionally been supportive including volume repletion, correcting arrhythmias, and repairing structural damage. Recently, there has been some promising alternative treatments including transcatheter closure of ventricular septal defects, anti-inflammatory agents, and post-injury therapeutic hypothermia. Although screening and diagnostic mechanism have remained relatively unchanged, it appears that innovative management of severe cardiac contusions has gained some momentum over the recent years.

Isolated Right Atrial Appendage Rupture from Blunt Chest Trauma: A Case Report

“…Autopsy studies have proved that the right atrial appendage is thinner than the right atrial wall and hence theoretically is more susceptible to rupture [5,15]. Moreover, the initial symptoms may be non-specific and can mimic other conditions and there is no universally accepted diagnostic criteria for the assessment of atrial rupture as there have been many documented presentations for such an injury in the literature [18]. The diagnosis of blunt cardiac injury remains difficult due to other associated injuries that divert the physician's attention, as well as the lack of specific physical findings and the lack of clinical suspicion of a specialized physician in an emergency room for the diagnosis of such an injury [10,6].…”

Attention: Cardiac Contusion

“…The mechanisms of a cardiac contusion are compression of the heart between sternum and spine, deceleration injury, and direct injury of broken ribs or sternum. [ 8 , 9 ] The incidence of blunt cardiac injury is about 20–76% in blunt thoracic trauma patients. [ 2 , 4 ] Cardiac contusion was detected in 16% of cases, which was proven by autopsy studies.…”

“…Although there are many studies about cardiac contusion, there is no gold standard for diagnosis in trauma patients admitted to emergency service. [ 8 , 9 , 14 , 15 ]…”

Restart the heart

“…The mortality caused by non-penetrating trauma to the anterior chest is either caused by structural injuries to the muscle (Contusio Cordis or Cardiac Contusion) or to electrical disturbances, such as ventricular fibrillation, in the absence of structural cardiovascular injury (Commotio Cordis) 4 5. The precise incidence of blunt cardiac injury (BCI) is difficult to estimate, though it is reported to be one of the main causes of out of hospital cardiac arrest (OHCA) in young athletes 5 6…”