Cardiac Contusion

1. See Also
   1. Cardiac Tamponade
   2. Blunt Chest Trauma
   3. Lung Contusion
   4. Hemothorax
   5. Pneumothorax
   6. Traumatic Aortic Disruption
   7. Diaphragmatic Rupture
   8. Esophageal Rupture
   9. Bronchial Tear
   10. Sternal Fracture
   11. Commotio Cordis
2. Causes
   1. Chest Traumatic Injury
   2. High speed injury (e.g. MVA)
   3. Sternal Fracture
3. History
   1. Bent stearing wheel in a Motor Vehicle Accident
4. Symptoms
   1. Chest Pain
5. Signs
   1. Hypotension
   2. Anterior chest wall injury
   3. Sternal Fracture signs
      1. Sternal tenderness
      2. Sternal deformity
6. Labs
   1. Serial Troponin levels
      1. Standard Troponin at 4-6 hours or High Sensitivity Troponin at 3 hours after injury
7. 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
8. 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
9. 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
10. Differential Diagnosis
    1. See Blunt Chest Trauma
    2. See associated conditions below
    3. Rib Fracture
11. Associated Conditions
    1. See Blunt Chest Trauma
    2. Heart Injury
       1. Valve Rupture
       2. Coronary Artery Dissection
       3. Cardiac Chamber Rupture
       4. Cardiac Tamponade
       5. Commotio Cordis
    3. Other Chest Injury
       1. Lung Contusion
       2. Hemothorax
       3. Pneumothorax
       4. Traumatic Aortic Disruption
       5. Diaphragmatic Rupture
       6. Esophageal Rupture
       7. Bronchial Tear
12. 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
13. Complications
    1. Cardiogenic failure
    2. Arrhythmia (including lethal, ventricular arrhythmia)
14. 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