Diagnosis, work-up and management of blunt cardiac injuries

Abstract

Blunt cardiac injury has a wide spectrum of clinical presentations, some of them quite severe. Its definition varies throughout the literature. The purpose of this review is to describe the epidemiology, screening, diagnosis and management of blunt cardiac injury. Blunt cardiac injury complicates up to 30% of severe blunt force trauma. It can be classified into electrical and structural abnormalities. Screening modalities include electrocardiogram and cardiac enzymes. Serial negative electrocardiograms and troponins can safely rule out blunt cardiac injury. A transthoracic echocardiogram should be performed if persistent dysrhythmia or hypotension. All dysrhythmias should be treated. Patients with structural abnormalities rarely survive. In conclusion, blunt cardiac injury is prevalent after significant blunt trauma. The appropriate screening modalities should be employed and any abnormality to be treated.

Sternal fractures and thoracic injury: an analysis of 288 sternal fractures attending a major trauma centre

“…Additionally, the most fractured region of the sternum was the midbody (34%). This is in keeping with the evidence to suggesting the MVA association with SF is due to sudden decelerating forces acting on the chest as it collides directly with safety restraints or the steering wheel [ 19 , 20 ].…”

Sudden death due to the atrioventricular node contusion

“…[14] Cardiac contusion happens in approximately 30% of severe blunt force trauma cases. [15] The mechanism of cardiac injury involves a sequence of events beginning with direct impact to the chest wall with transmission of the kinetic force to the patient, and this results in compression of the heart between the sternum and the spine. [4,16] The AVN is very vulnerable to damage when there is cardiac contusion.…”