Evaluation of noninvasive tests of cardiac damage in suspected cardiac contusion.

Abstract

Nonpenetrating trauma to the chest can result in cardiac damage that may be overlooked because of associated injuries and the lack of obvious thoracic injury. The clinical diagnosis of important cardiac damage in this setting is difficult. We evaluated noninvasive tests for detecting myocardial damage in 100 patients with severe, nonpenetrating chest trauma. The noninvasive tests included serial ECG, serial total CPK and CPK-MB enzymes, continuous Holter monitor recording to detect dysrhythmia, and technetium-99m pyrophosphate scintigraphy. Peak CPK-MB elevations occurred in 72 patients. ECG abnormalities were noted in 70 patients, and 27 patients had Lown grade 3 or greater dysrhythmias. Fifteen patients died and all had autopsies. The noninvasive abnormalities were nonspecific and did not reflect myocardial contusion that led to clinically important cardiac complications.

The Relationship of Trauma Severity and Mortality with Cardiac Enzymes and Cytokines at Multiple Trauma Patients

“…It has been reported that every kind of arrhythmia can be diagnosed, while sinus tachycardia, ST-T wave change, ventricular fibrillation, premature atrial and ventricular discharges, atrial fibrillation, and AV blocks have a higher frequency of occurrence and of being diagnosed. [12,14,15] In our study, abnormal ECG finding was determined in 63 of 100 patients. Of these, sinus tachycardia was detected in 36%, right branch block in 13%, ST-T wave changes in 10%, and sinus bradycardia in 4%.…”

“…[12,13] A meta-analysis by Maenza et al [14] showed a concordance between important cardiac complications and abnormal ECG findings. It has been reported that every kind of arrhythmia can be diagnosed, while sinus tachycardia, ST-T wave change, ventricular fibrillation, premature atrial and ventricular discharges, atrial fibrillation, and AV blocks have a higher frequency of occurrence and of being diagnosed.…”

Efficacy of cardiac magnetic resonance for the qualitative diagnosis of blunt cardiac injury

“…8 It is attributed to the more anterior location of the right-sided cardiac structures. 9 "Commotio cordis" is a term used for cases of sudden cardiac death due to non-penetrating chest trauma without evidence of underlying myocardial disease or injury.…”

Challenges in the diagnosis of blunt cardiac injuries

“…99 m-Tc pyrophosphate scan can detect the myocardial necrosis but has low sensitivity and higher false negative rate [61]. Since, there is a higher likelihood of injury of the right ventricle and the right ventricle has a lower mass relative to the left ventricle, the scintigraphic detection of right ventricular necrosis is diffi cult [14].…”