II. Causes

  1. Chest Traumatic Injury
  2. High speed injury (e.g. MVA)
  3. Sternal Fracture

III. History

  1. Bent stearing wheel in a Motor Vehicle Accident

IV. Symptoms

V. Signs

  1. Hypotension
  2. Anterior chest wall injury
  3. Sternal Fracture signs
    1. Sternal tenderness
    2. Sternal deformity

VI. Labs

  1. Serial Troponin levels
    1. Standard Troponin at 4-6 hours or High Sensitivity Troponin at 3 hours after injury

VII. Diagnostics

  1. Telemetry monitoring
  2. Electrocardiogram (EKG) - obtain serial EKGs
    1. See EKG monitoring in Trauma
    2. Changes occur typically in first 8-24 hours of injury and typically resolve spontaneously
    3. Premature Ventricular Contractions (PVC)
    4. Unexplained Sinus Tachycardia
    5. Atrial Fibrillation (most common arrhythmia)
    6. Right Bundle Branch Block
    7. ST Segment changes
      1. Myocardial Infarction may occur in blunt cardiac Trauma
  3. Advanced hemodynamic monitoring (if central access)
    1. Central Venous Pressure increased

VIII. Imaging

  1. FAST Exam
    1. Pericardial Effusion may be present
  2. Echocardiogram
    1. Wall motion abnormality
    2. Right Ventricle is most commonly injured chamber in Sternal Fracture
    3. Evaluate for valvular injury

IX. Evaluation

  1. Normal Troponin, EKG, hemodynamic and cardiac monitoring without significant other Chest Injury
    1. Unlikely to have significant cardiac injury
    2. May be discharged home after 6 hour observation
  2. Abnormal Troponin, EKG hemodynamic or cardiac monitoring (esp. in displaced Sternal Fracture, other Chest Trauma)
    1. Complete full evaluation with Echocardiogram, telemetry, trauma Consultation

X. Differential Diagnosis

  1. See Blunt Chest Trauma
  2. See associated conditions below
  3. Rib Fracture

XII. Management

  1. ABC Management
  2. Manage Hypoxia, Hypotension and identified complications
  3. Indications for observation (24-48 hour)
    1. See Evaluation above
    2. Complications (see below) are most likely to present in the first 24-48 hours

XIII. Complications

  1. Cardiogenic failure
  2. Arrhythmia (including lethal, ventricular arrhythmia)

XIV. References

  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21
  2. (2012) ATLS, ACOS, p. 105
  3. Killu and Sarani (2016) FCCS, p. 160-1

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Related Studies

Ontology: Contusion to heart (C0273112)

Definition (NCI_FDA) A bruise to the heart.
Definition (NCI) A bruise to the heart.
Concepts Injury or Poisoning (T037)
ICD10 S26.81
SnomedCT 210054006, 17414004
English Myocardial Contusion, myocardial contusion (diagnosis), myocardial contusion, cardiac contusions, cardiac contusion, contusion heart, contusions heart, heart contusion, CONTUSION, MYOCARDIAL, MYOCARDIAL CONTUSION, CARDIAC CONTUSION, CONTUSION, CARDIAC, Cardiac contusion, Contusion to heart, Myocardial contusion, Contusion of heart, Contusion to heart (disorder)
Czech Konture srdce, Kontuze myokardu
Dutch myocardcontusie, hartkneuzing
French Contusion myocardique, Contusion cardiaque
German Herzkontusion, Myokardprellung
Hungarian Szív-contusio, Myocardialis contusio
Italian Contusione miocardica, Contusione cardiaca
Japanese シンゾウザショウ, シンキンザショウ, 心筋挫傷, 心臓挫傷
Portuguese Contusão cardíaca, Contusão miocárdica
Spanish Contusión cardiaca, Contusión miocárdica, contusión cardíaca, contusión miocárdica (trastorno), contusión miocárdica