How is a myocardial contusion diagnosed?
Cardiac contusion is usually caused by blunt chest trauma and therefore is frequently suspected in patients involved in car or motorcycle accidents. The diagnosis of a myocardial contusion is difficult because of non-specific symptoms and the lack of an ideal test to detect myocardial damage.
What are the signs and symptoms of a cardiac contusion?
You may not have symptoms other than a fast heartbeat if your myocardial contusion is mild. If your myocardial contusion is bad, it may feel like you’re having a heart attack. Shortness of breath. Lightheadedness. Upset stomach. Heart palpitations. Pain in your ribs (chest). What causes a cardiac contusion?
Can cardiac contusion be predicted by ECG?
Cardiac contusion can cause life threatening arrhythmias and cardiac failure. Many diagnostic methods, such as ECG, biochemical cardiac markers, transthoracic and transoesophageal echocardiography, and radionuclide imaging studies, have been investigated to determine their use in predicting such complications.
Which histologic findings are characteristic of cardiac contusion?
A cardiac contusion is histologically characterised by intramyocardial haemorrhage, oedema, and necrosis of myocardial muscle cells. These histological findings are almost similar to those seen in acute myocardial infarction. 13,22 Therefore, cardiac enzyme determinations were the first screening tool used to detect myocardial injury.
How is blunt cardiac injury diagnosed?
Diagnosis of Blunt Cardiac Injury Cardiac injury should be suspected in patients with significant chest trauma and any palpitations, arrhythmia, new cardiac murmur, or unexplained tachycardia or hypotension.
What are the symptoms of a bruised heart?
What are the symptoms of a myocardial contusion?extreme pain above the ribs.an increased heart rate.weakness.excessive fatigue.lightheadedness.nausea.vomiting.shortness of breath.
Which type of ECG changes is most commonly seen with myocardial contusion?
Patients with suspected blunt cardiac injury should have an ECG. Various nonspecific abnormalities are possible in contusion: The most common is sinus tachycardia. Continuous ECG monitoring for 24 to 48 hours is recommended when abnormalities are found.
What happens if your heart gets bruised?
Blunt injury to the heart is a blow to the chest that bruises the heart muscle, tears (ruptures) the heart's walls, or damages a heart valve. People may feel that their heart is pounding or racing, feel short of breath, or have dangerously low blood pressure.
How long does a bruised heart take to heal?
Stretch slowly to the point just before discomfort begins, then hold the stretch for at least 15 to 30 seconds. Do this 3 or 4 times per day. As your pain gets better, slowly return to your normal activities. Be patient, because chest bruises can take weeks or months to heal.
Which is the best indicator of myocardial injury?
The most sensitive early marker for myocardial infarction is myoglobin. Troponin levels should be measured at presentation and again 10-12 hours after the onset of symptoms.
Which test is most indicative of cardiac damage?
A troponin test measures the levels of troponin T or troponin I proteins in the blood. These proteins are released when the heart muscle has been damaged, such as occurs with a heart attack. The more damage there is to the heart, the greater the amount of troponin T and I there will be in the blood.
What is the most sensitive marker for myocardial damage?
Troponin I is extremely specific for the cardiac muscle and has not been isolated from the skeletal muscle. This absolute specificity makes it an ideal marker of myocardial injury (41). They are released into the circulation 6–8 h after myocardial injury, peak at 12–24 h and remain elevated for 7–10 days (42).
How do you fix a bruised heart?
How Is a Myocardial Contusion Treated?Medicine to relieve pain.Medicine for low blood pressure.Medicine for a heart rate disturbance.Pacemaker.Oxygen.Chest tube.Drainage of blood around the heart.Surgery to repair your heart.
What does a damaged heart feel like?
Discomfort, pressure, heaviness, or pain in the chest, arm, or below the breastbone. Discomfort radiating to the back, jaw, throat, or arm. Fullness, indigestion, or choking feeling (may feel like heartburn) Sweating, nausea, vomiting, or dizziness.
Can you feel a damaged heart?
The most common signs and symptoms of broken heart syndrome are angina (chest pain) and shortness of breath. You can experience these things even if you have no history of heart disease. Arrhythmias (abnormal heartbeats) or cardiogenic shock also may occur with broken heart syndrome.
Can an injured heart heal itself?
But the heart does have some ability to make new muscle and possibly repair itself. The rate of regeneration is so slow, though, that it can't fix the kind of damage caused by a heart attack. That's why the rapid healing that follows a heart attack creates scar tissue in place of working muscle tissue.
What is a bruised heart muscle?
A myocardial contusion is a bruise of the heart muscle, which can occur with serious bodily injury. This is most commonly caused: Myocardial contusion shouldn’t be confused with infarction. Myocardial infarction, or a heart attack, occurs when the heart is severely damaged as a result of a lack of blood flow to the muscle.
What causes contusions in the heart?
Bodily injuries and accidents cause contusions of the heart. The heart muscle can be bruised if blunt force or pressure impacts the chest. The most common causes of this condition include: falls. car accidents. being struck by a car. CPR injuries.
What is the best treatment for chest pain?
placement of a pacemaker to help regulate heartbeat. Over-the-counter medications, such as acetaminophen (Tylenol) and ibuprofen (Advil), may also be recommended to help relieve pain.
What are the symptoms of a heart contusion?
an increased heart rate. weakness. excessive fatigue. lightheadedness. nausea. vomiting. shortness of breath. Any of these symptoms should be evaluated immediately. The symptoms of severe heart contusions may mimic those of a heart attack.
How long does it take for an electrocardiogram to be performed?
The type of treatment you receive depends on your injuries. In some cases, electrocardiograms are performed for 24 hours to monitor the heart on a continuous basis. Emergency treatment may include oxygen if you’re experiencing breathing problems.
What is the purpose of a CT scan of the heart?
a CT scan of heart. an echocardiogram to visualize the flow of blood through the heart. an electrocardiogram to monitor the heart’s electrical activity. a complete blood count, which can help your doctor determine the presence of certain enzymes in the blood that appear when the heart muscle and tissues are damaged.
What does a doctor look for in a heart injury?
For example, your doctor may evaluate your chest for bruises. Your doctor will also look for: low blood pressure. an irregular heart rate. a rapid heartbeat.
What Causes a Myocardial Contusion?
A myocardial contusion happens as a result of blunt force trauma. Your heart is well-protected by the bones of your chest, so it takes a lot of force to damage it. The most common causes are:
What type of injury results from blunt trauma to the chest?
A particular type of injury that results from blunt trauma to the chest is commotio cordis. This type of injury doesn't cause direct damage to the heart muscle. Instead, blunt trauma, such as the kind that occurs when the left side of the chest is hit with a baseball, interrupts the heart's rhythm. This causes sudden cardiac arrest in an otherwise structurally normal heart.
What is a bruised heart muscle?
A myocardial contusion is a bruise to your heart muscle. It's caused by blunt force to your chest. It may tear the wall of your heart or damage your heart valve.
What is the rupture of the ventricular septum?
Rupture of the ventricular septum, which is the wall separating the two lower chambers of the heart
Can myocardial contusions be prevented?
Not all myocardial contusions can be prevented. However, the following tips may help:
Should healthcare providers be available during sporting events?
If possible, a healthcare provider should be available during sporting events to advise and assist in emergencies.
What are the causes of cardiac arrhythmias after trauma?
Cardiac arrhythmias, after trauma, can be indicative of myocardial injury. They can also occur secondary to the altered biochemistry or acid base balance associated with hypoxia and tissue hypoperfusion. Underlying cardiac disease can be exacerbated by trauma. Some patients will have had a primary cardiac event as the precipitating cause for the injury. The treatment of arrhythmias after major trauma is expectant and supportive as per ALS periarrest guidelines. All patients with ECG morphology or rhythm disturbances should have cardiac monitoring for at least 24 hours. Biochemical abnormalities should be actively managed. Early echocardiography is the imaging investigation of choice. Anaesthesia and DC cardioversion are avoided where possible.
What causes a cardiac contusion?
Cardiac contusion is caused by a deceleration force affecting the viscoelastic chest wall causing (1) direct pressure on myocardium and (2) indirect effects secondary to increased intrathoracic pressures with shearing stresses. Experimental evidence shows a sternal blow can reduce the AP diameter of the thorax by 50%.
What did Schick and al14 show about rabbits?
Schick et al14 in experiments on rabbits demonstrated transient non-specific ST segment and T wave changes after blunt thoracic trauma, which correlated with RV contusions at necropsy.
How long does it take for ventricular dysfunction to occur?
Ventricular dysfunction and arrhythmia are the two most serious complications. Arrhythmia usually occur within 24 hours (91% within 48 hours). The need for intervention has been reported at between zero to 20%, 3 depending upon diagnostic criteria and intervention threshold.
Why is the right ventricle injured?
The right ventricle (RV) is most commonly injured because of its position behind the sternum. Left ventricular (LV) output can fall in the absence of direct injury because of reduced preload. Reduced LV compliance from intraventricular septum shift also contributes to biventricular failure.
Is ECG sensitive to myocardial contusion?
These ECG changes were not predictive of cardiac complications or of myocardial contusion at necropsy in the 15 patients who died. ECGs are intrinsically unlikely to be sensitive in the diagnosis of myocardial contusion as they largely reflect atrial and LV activity, the LV mass electrically overshadowing the RV.
Is CTNI more sensitive than TOE?
It could equally represent minor cardiac contusion without wall motion abnormalities suggesting cTnI is more sensitive than TOE. In summary, cardiac troponins seem to be highly specific and sensitive for myocardial injury. They may offer the possibility of stratification of severity and risk of adverse outcome.
How is Myocardial Contusion Diagnosed?
To diagnose Myocardial Contusions, a physical exam will be conducted looking for the following signs:
What is a myocardial contusion?
A Myocardial Contusion is a medical condition where the heart muscle becomes bruised. Usually, heart muscle bruising results from injury to the chest wall. While bruising of the heart muscle is not always injurious by itself, often time’s complications occur that can increase the risk of life-threatening conditions.
What is the difference between a penetrating injury and a non-penetrating injury?
Penetrating injuries occur when the chest cavity is pierced while non-penetrating injuries involve crush or compression injuries. In both cases, the heart muscle is negatively impacted and injured, and bruising occurs as it heals itself.
What is the importance of wearing a seatbelt?
Wearing a seatbelt during vehicle rides, wearing safety equipment when doing risky activities, and taking care when under the influence of alcohol and drugs will all decrease the chance that injury occurs.
What is chest pain?
Chest pain/tenderness. Crunching sensation when skin is touched. Often times, medical professionals also conduct a variety of laboratory tests, including: Blood tests to determine heart muscle damage. Chest X-ray to determine damage to the chest wall.
Can a myocardial conusion be recovered?
In most cases of Myocardial Contusions, a complete recovery is possible. If the injury is severe, serious heart problems can continue to exist after recovery. With proper care, these problems can be maintained and individuals can live relatively normal lives.
Can a high risk job cause myocardial contusions?
In most cases, adults in high-risk jobs where injury is likely develop myocardial contusions.
What is the most devastating BCI?
Cardiac rupture is the most devastating BCI. Most patients who sustain rupture of a heart chamber do not reach the emergency department alive. Chamber rupture is described primarily in autopsy series [ 4,5 ]. (See 'Anatomy and mechanism of injury' below.)
What is blunt cardiac injury?
Blunt cardiac injury (BCI) encompasses a spectrum of pathology ranging from clinically silent, transient arrhythmias to deadly cardiac wall rupture. The most common form is "cardiac contusion" (ie, injury to the myocardium), which remains the subject of considerable debate. The absence of a clear definition and accepted gold standard for testing makes the diagnosis of cardiac contusion difficult. Important considerations in blunt cardiac trauma include arrhythmia, cardiac wall motion abnormalities, possibly progressing to cardiogenic shock, and rupture of valves, the septum, or a ventricular, atrial, or septal wall [ 1,2 ].
Is BCI a common injury?
The incidence of blunt cardiac injury (BCI) is unknown, and estimates vary widely. Of diagnosed BCIs, "myocardial contusion" or "cardiac contusion" is most common. However, each of these terms has been used to refer to a range of cardiac injuries. The absence of clear diagnostic criteria and reliable diagnostic tests makes reporting difficult.
Background
Clinical Features
- Chest pain
- Palpitations
- Tachycardia
- Dyspnea/shortness of breath
Differential Diagnosis
- Thoracic Trauma
1. Airway/Pulmonary 1.1. Bronchial injury 1.2. Diaphragmatic trauma 1.3. Hemothorax 1.4. Pneumomediastinum 1.5. Pulmonary contusion 1.6. Tracheal injury 1.7. Trachobronchial injury 1.8. Traumatic pneumothorax 1.8.1. Tension pneumothorax 2. Cardiac/Vascular 2.1. Cardiac inj…
Evaluation
- Diagnosis is difficult due to spectrum of clinical disease and lack of adequate test in the ED 1. Physical exam 1.1. Majority (75%) of patients will have evidence of chest wall trauma 2. Imaging 2.1. CXRand CT Chest are neither sensitive nor specific for cardiac contusion, but may show other blunt cardiac injury 2.2. Echocardiography may be useful ...
Management
- Treatment is generally supportive and based on clinical presentation
- Do NOT treat arrhythmias prophylactically (increased mortality!)
- Do NOT give thrombolytics for signs of myocardial infarction(increased mortality)
Disposition
- Patients with mild injury, normal ECG, and negative Troponin can likely be discharged after period of observation
- Admit to telemetry bed for:
See Also