II. Causes
- Chest Traumatic Injury
- High speed injury (e.g. MVA)
- Sternal Fracture
III. History
- Bent stearing wheel in a Motor Vehicle Accident
IV. Symptoms
V. Signs
- Hypotension
- Anterior chest wall injury
-
Sternal Fracture signs
- Sternal tenderness
- Sternal deformity
VI. Labs
- Serial Troponin levels
- Standard Troponin at 4-6 hours or High Sensitivity Troponin at 3 hours after injury
VII. Diagnostics
- Telemetry monitoring
-
Electrocardiogram (EKG) - obtain serial EKGs
- See EKG monitoring in Trauma
- Changes occur typically in first 8-24 hours of injury and typically resolve spontaneously
- Premature Ventricular Contractions (PVC)
- Unexplained Sinus Tachycardia
- Atrial Fibrillation (most common Arrhythmia)
- Right Bundle Branch Block
- ST Segment changes
- Myocardial Infarction may occur in blunt cardiac Trauma
- Advanced hemodynamic monitoring (if central access)
- Central Venous Pressure increased
VIII. Imaging
-
FAST Exam
- Pericardial Effusion may be present
-
Echocardiogram
- Wall motion abnormality
- Right Ventricle is most commonly injured chamber in Sternal Fracture
- Evaluate for valvular injury
IX. Evaluation
- Normal Troponin, EKG, hemodynamic and cardiac monitoring without significant other Chest Injury
- Unlikely to have significant cardiac injury
- May be discharged home after 6 hour observation
- Abnormal Troponin, EKG hemodynamic or cardiac monitoring (esp. in displaced Sternal Fracture, other Chest Trauma)
- Complete full evaluation with Echocardiogram, telemetry, trauma Consultation
X. Differential Diagnosis
- See Blunt Chest Trauma
- See associated conditions below
- Rib Fracture
XI. Associated Conditions
- See Blunt Chest Trauma
- Heart Injury
- Valve Rupture
- Coronary Artery Dissection
- Cardiac Chamber Rupture
- Cardiac Tamponade
- Commotio Cordis
- Other Chest Injury
XII. Management
- ABC Management
- Manage Hypoxia, Hypotension and identified complications
- Indications for observation (24-48 hour)
- See Evaluation above
- Complications (see below) are most likely to present in the first 24-48 hours
XIII. Complications
- Cardiogenic failure
- Arrhythmia (including lethal, ventricular Arrhythmia)
XIV. References
- Dreis (2020) Crit Dec Emerg Med 34(7):3-21
- (2012) ATLS, ACOS, p. 105
- Killu and Sarani (2016) FCCS, p. 160-1
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Related Studies
| 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 | ｼﾝｿﾞｳｻﾞｼｮｳ, ｼﾝｷﾝｻﾞｼｮｳ, 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 |
