Emergency Medicine Book

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Cardiac Contusion

Aka: Cardiac Contusion, Blunt Cardiac Injury, Blunt Myocardial Injury, Myocardial Contusion, Heart 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

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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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