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Myocardial Contusion


Presentation

  • Two patients (4%) presented with ECG abnormalities and only 1 patient (2%) presented with an elevated troponin I level.[ncbi.nlm.nih.gov]
  • The pathophysiology, clinical presentation, and a critical evaluation of the diagnostic tests used in the confirmation of this entity are reviewed, and an approach to the evaluation and management of these patients is presented.[ncbi.nlm.nih.gov]
  • Abstract Cardiac contusion may be frequently found in patients with blunt chest trauma, and it presents clinically as a spectrum of injuries of varying severity, including transient disorders of impulse formation and propagation.[ncbi.nlm.nih.gov]
  • Using the reported search, 75 papers were found, of which six presented the best evidence to answer the clinical question.[ncbi.nlm.nih.gov]
  • Abstract A patient with myocardial trauma following blunt chest injury is presented who returned 4 months later with persistent cardiac symptoms.[ncbi.nlm.nih.gov]
Chest Pain
  • A young man was in a rollover Motor Vehicle Collision, with a chest laceration and chest pain.[hqmeded-ecg.blogspot.com]
  • A fractured sternum indicates high kinetic energy at the impact and elevated Troponin levels and chest pain after such an injury confirm myocardial contusion.[radiopaedia.org]
  • Clinical picture is varied and nonspecific: Chest pain Cardiogenic shock Subtle EKG changes without clinical symptoms Most common sign is tachycardia out of proportion to degre...[5minuteconsult.com]
  • Medicines may be prescribed to relieve chest pain, heart rate abnormalities, or low blood pressure that can arise from Myocardial Contusions.[dovemed.com]
  • Signs and symptoms can include: arrhythmias, or irregular heartbeats severe chest pain shortness of breath Diagnosis & Tests How is the condition diagnosed? Diagnosis of myocardial contusion begins with a medical history and physical exam.[medicineonline.com]
Heart Disease
  • Of these patients, 6 had biventricular dysfunction, 1 had isolated abnormal left ventricular function, and 2 had isolated abnormal right ventricular function in the absence of chronic obstructive pulmonary disease or preexisting heart disease.[ncbi.nlm.nih.gov]
  • Traumatic heart disease. In: Levine GN, ed. Cardiology Secrets. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 71. Raja AS. Thoracic trauma. In: Walls RM, Hockberger RS, Gausche-Hill M, eds.[medlineplus.gov]
  • Attribution Author: Eric Berlin, MD Date Written: Editor: Ballenberg, Sally, BS Edit Date: 08/31/01 Reviewer: Eileen McLaughlin, RN, BSN Date Reviewed: 07/31/01 Sources Merck Manual 1999 Harrison's Principles of Internal Medicine 1991 Heart Disease: A[medicineonline.com]
  • (Also known as/Synonyms) Blunt Myocardial Injury Traumatic Heart Disease What is Myocardial Contusion? (Definition/Background Information) A Myocardial Contusion is a medical condition where the heart muscle becomes bruised.[dovemed.com]
  • Commotio cordis is sudden cardiac arrest that follows a blow to the anterior chest wall in patients who do not have pre-existing or traumatic structural heart disease.[msdmanuals.com]
Suggestibility
  • Ten patients had echocardiograms suggestive of cardiac contusion. Of these ten, three had no detectable CPK/MB and six had CPK/MB of less than 5%. CPK/MB had a sensitivity of 70% and a specificity of 27.5%.[ncbi.nlm.nih.gov]
  • Of 38 patients, 32 had localized ST-T segment abnormalities; 29, ST-T segment abnormalities suggesting involvement of the same cardiac area as scintigraphic defects; 21, echocardiographic abnormalities.[ncbi.nlm.nih.gov]
  • Criteria for observation following isolated, minor blunt chest trauma are suggested. Hospital and trauma registry records of patients admitted over a 33-month period with suspected MCC were reviewed.[ncbi.nlm.nih.gov]
  • We report a case and review the literature of thromboembolism complicating blunt heart injury, and suggest a protocol to prevent this complication.[ncbi.nlm.nih.gov]
  • Careful review suggests that clinically significant myocardial contusions as a result of blunt trauma are rare and may be detected simply and inexpensively using electrocardiography and careful physical examination.[ncbi.nlm.nih.gov]

Workup

  • Of the 644 admissions to monitored beds, 95 had workups for suspected contusion. Heart failure not obvious on admission did not occur and there were only four arrhythmias that required treatment.[ncbi.nlm.nih.gov]
  • […] entire study period CONCLUSIONS: Levels of cTnI below 1.05 microg/L in asymptomatic patients at admission and within the first 6 hours after admission rule out myocardial injury, whereas positive cTn levels above 1.05 microg/L mandate further cardiologic workup[ncbi.nlm.nih.gov]
  • The initial workup revealed elevated cardiac troponin T of 0.576 μg/L (normal range, 0.00 to 0.03 μg/L) and creatine kinase-MB levels of 25.4 U/L (normal range, 0 to 25 U/L); the markers of inflammation proved to be negative (C-reactive protein level,[circ.ahajournals.org]
  • Loss of the aortic knob contour, shift of the esophagus (nasogastric tube) to the right and an apical cap in addition to mediastinal widening indicate need for further workup.[4, 5] Aortic Injury 80-90% of patients with thoracic aortic rupture die in[trauma.org]
Mural Thrombus
  • Echocardiography showed global right ventricular dysfunction but a right ventricular mural thrombus, the likely source of the pulmonary emboli, was not seen. He gradually recovered after treatment with anticoagulant.[ncbi.nlm.nih.gov]
ST Elevation
  • The next morning There is increased ST elevation Troponin Profile:[hqmeded-ecg.blogspot.com]
  • […] pathcy myocyte necrosis, edema,scar formation what is the most important sequele of cardiac contrusion HYPOTENSION and ARRHYTMIA investigations of cardaic contusion ECG: pericarditis like ST elevation, RBBB; AV nodal abnormlaities cardiac markers : levels[quizlet.com]
  • An electrocardiogram reveals diffused ST elevations and sinus tachycardia. A focused assessment with sonography in trauma (FAST) exam reveals pericardial fluid.[medbullets.com]
  • The 12-lead surface ECG showed ST-elevation in lead V 3 and deep T-wave inversions across the precordial leads ( Figure 1 A).[circ.ahajournals.org]
  • elevation (less frequent); ECG may be normal Electrical conduction system adversely affected by myocardiac ischemia due to injury; 65% of people with myocardial contusion have ECG changes Creatine kinase isoenzyme (MB-CK) Elevated in some patients Some[medical-dictionary.thefreedictionary.com]
Atrioventricular Dissociation
  • One month later he presented with a further complication--complete atrioventricular dissociation--that required a dual chamber pacemaker implantation.[ncbi.nlm.nih.gov]
T Wave Inversion
  • She evolved favorably, with no progression of the pericardial effusion, although electrocardiographically she presented more T-wave inversion in the anterior wall and minimal elevation of ST in I and aVL.[elsevier.es]
  • The 12-lead surface ECG showed ST-elevation in lead V 3 and deep T-wave inversions across the precordial leads ( Figure 1 A).[circ.ahajournals.org]
  • […] short pulses of ultrasonic beam off structures; may be done as transesophageal to left ventricular procedure with transmitter inserted into esophagus (transesophageal echocardiogram) Electrocardiogram (ECG) Normal PQRST pattern ST segment depression, T-wave[medical-dictionary.thefreedictionary.com]
Ischemic Changes
  • changes without cardiac failure Penetrating tangential cardiac wound, up to but not extending through endocardium, without tamponade Grade III Blunt cardiac injury with sustained or multifocal ventricular contracations Blunt or penetrating cardiac injury[aast.org]

Treatment

  • We review the clinical pathology, diagnostic tools, and treatment for MCI.[ncbi.nlm.nih.gov]
  • Abstract The body of literature devoted to the diagnosis and treatment of the patient with myocardial contusion (MC) frequently references the "index of suspicion" to qualify those patients at risk for cardiac embarrassment.[ncbi.nlm.nih.gov]
  • When complications such as cardiogenic shock occur, aggressive treatment using Swan-Ganz catheterization for monitoring of intravascular volume and cardiac inotropic support are necessary.[ncbi.nlm.nih.gov]
  • Through use of a case study approach, this article demonstrates that a myocardial contusion has many similarities in terms of pathophysiologic changes with that of a myocardial infarction, often confusing symptoms and therefore diagnosis and treatment[ncbi.nlm.nih.gov]

Prognosis

  • Outcome and prognosis in patients with MC is favorable and, thus, routine cardiac work-up is not indicated. Specific diagnostic and therapeutic measures should be limited to cases where cardiac complications develop.[ncbi.nlm.nih.gov]
  • Expectations (prognosis) The expectation is that a full recovery will occur. Complications The main complication is that the bruising may lead to myocardial infarction (heart muscle death).[medical-dictionary-search-engines.com]
  • Outlook (Prognosis) Return to top You should recover fully. In non-severe cases, the bruised part of the heart often regains its function without any permanent scarring.[pacificschoolserver.org]
  • […] low blood pressure Pacemaker (temporary, may be permanent later) Oxygen Other therapies may be used to treat a heart injury, include: Chest tube placement Draining blood from around the heart Surgery to repair blood vessels in the chest Expectations (prognosis[coordinatedhealth.com]
  • […] heart rhythm disturbances, or low blood pressure Pacemaker Supplemental oxygen Various therapies for injuries, such as chest tube placement, drainage of blood from the pericardial sac, or surgery to repair ruptured blood vessels in the chest Outlook (Prognosis[healthmedicinet.com]

Etiology

  • (Etiology) Myocardial Contusions are caused by injuries to the heart muscle that result in bruising. Myocardial contusions can occur from penetrating, non-penetrating, or a combination of both types of chest injuries.[dovemed.com]
  • […] of blunt cardiac trauma patients with frank cardiac rupture often do not even make it to the emergency room Presentation Symptoms chest pain difficulty breathing palpitations lightheadedness Physical exam physical exam findings depend on etiology patients[medbullets.com]
  • […] bruising of the myocardium-hematoma of the myocardium rare occurance that occurs due to extreme blunt force. describe cardiac contrusion when to suspect cardiac contusion if persistet hypotension and no signs of hemorrhage etiology of cardiac contusion[quizlet.com]
  • Circulation Since hypotension in thoracic trauma is usually associated with hypovolemia it should be aggressively treated initially with volume expansion with crystalloids while other possible etiologies, i.e. pneumothorax, cardiac tamponade and blunt[trauma.org]

Epidemiology

  • A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest. Ann Emerg Med. ‎[books.google.it]
  • Introduction Clinical definition trauma to the thoracic cage, resulting in cardiac injury Epidemiology location right ventricle is most commonly injured it is right below the sternum aortic valve is the most common valve to be injured risk factors motor[medbullets.com]
Sex distribution
Age distribution

Pathophysiology

  • The pathophysiology, clinical presentation, and a critical evaluation of the diagnostic tests used in the confirmation of this entity are reviewed, and an approach to the evaluation and management of these patients is presented.[ncbi.nlm.nih.gov]
  • Through use of a case study approach, this article demonstrates that a myocardial contusion has many similarities in terms of pathophysiologic changes with that of a myocardial infarction, often confusing symptoms and therefore diagnosis and treatment[ncbi.nlm.nih.gov]
  • […] a spectrum of injuries Mild / minor (transient) Myocardial bruising Temporary dysrhythmias Decreased contractility Serious Ventricular free wall rupture Injury mechanism Direct blows to chest (high-speed impact) MVCs, falls Crush and blast injuries Pathophysiology[fprmed.com]
  • . * cardiac surgery *rarely MI : more often caused by the adm.of CPR pathophysiology of cardiac contrusion deceleration injury that affects the chest wall : direct pressure on the myocardium. intrathoracic pressure , leads to shearing stress.[quizlet.com]
  • Pathophysiology is unclear, but the timing of the blow in relation to the cardiac cycle may be important. Initial rhythm is usually ventricular fibrillation.[msdmanuals.com]

Prevention

  • We report a case and review the literature of thromboembolism complicating blunt heart injury, and suggest a protocol to prevent this complication.[ncbi.nlm.nih.gov]
  • Increased awareness of myocardial contusion is required for earlier diagnosis and prevention of complications.[ncbi.nlm.nih.gov]
  • Prevention Keys to preventing myocardial contusion are basic safety precautions, including wearing a seat belt when driving and purchasing an automobile with air bags. Update Date: 4/13/2004 John A.[medical-dictionary-search-engines.com]
  • Prevention Return to top Basic safety precautions are keys to preventing myocardial contusion. Wear a seat belt when driving and purchase an automobile with air bags. Update Date: 5/15/2008 Updated by: Robert A.[pacificschoolserver.org]

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