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
2. Causes
   1. Chest Traumatic Injury
   2. High speed injury (e.g. MVA)
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
   2. Serum myoglobin
   3. Serum CK-MB
7. Diagnostics
   1. Telemetry monitoring
   2. Electrocardiogram (EKG) - obtain serial EKGs
      1. See EKG monitoring in Trauma
      2. Premature Ventricular Contractions (PVC)
      3. Unexplained Sinus Tachycardia
      4. Atrial Fibrillation
      5. Right Bundle Branch Block
      6. 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
   2. Echocardiogram
      1. Wall motion abnormality
9. Differential Diagnosis
   1. See Blunt Chest Trauma
   2. See associated conditions below
   3. Rib Fracture
10. Associated Conditions
    1. Heart Injury
       1. Valve Rupture
       2. Coronary Artery Dissection
       3. Cardiac Chamber Rupture
       4. Cardiac Tamponade
    2. Other Chest Injury
       1. Lung Contusion
       2. Hemothorax
       3. Pneumothorax
       4. Traumatic Aortic Disruption
       5. Diaphragmatic Rupture
       6. Esophageal Rupture
       7. Bronchial Tear
11. Management
    1. ABC Management
    2. Manage Hypoxia, Hypotension and identified complications
    3. Indications for observation (24 hour)
       1. Electrocardiogram abnormalities
12. References
    1. (2012) ATLS, ACOS, p. 105
    2. Killu and Sarani (2016) FCCS, p. 160-1