Abstract
Introduction
Blunt thoracic injuries (BTIs) are directly responsible for 20–25% of all deaths, worldwide. Involvement of heart in BTIs is largely underestimated and ignored, but reasonable estimate would be around 15%. This study was planned to emphasize on clinical-presentation and diagnosis of blunt cardiac injuries (BCIs).
Results
Clinical presentation of BCIs, varied from mild chest discomfort to haemodynamic shock secondary to rapid exsanguinations. Non-specific presentation with associated injuries diverts physician’s attention and delayed appearance of clinical features makes diagnosis further difficult. Cardiac markers and ECG are not specific, but high sensitivity of 100% could be reached using combination of elevated cardiactroponin levels and alterations in ECG. Transoesophageal or transthoracic echocardiography, angiography, intravascular ultrasound and nuclear scan have proven to detect cardiac injuries in BTIs, but lack specificity.
Conclusion
Patients with suspicious-ECG finding need cardiac-monitoring for at least 24 hours. Haemodynamically stable young (<55 years) subjects, without underlying cardiac diseases and with normal-ECG and cardiac marker, could be discharged safely.
Similar content being viewed by others
References
Kung HC, Hoyert DL, Xu J, Murphy SL (2008) Deaths: Final Data for 2005. National Vital Statistics report: 56; 10
Mortality Country Fact Sheet 2006. India, WHO. available on (http://www.who.int/whosis/mort/profiles/mort_searo_ind_india.pdf). Accessed on May 22nd 2009
Mattox KL, Flint LM, Carrico CJ, et al. (1992) Blunt cardiac injury. J Trauma 33(5):649–650
Tenzer ML (1985) The spectrum of myocardial contusion: a review. J Trauma 25:620–627
Zajarias A, Thanigaraj S, Taniuchi M (2006) Acute coronary occlusion and myocardial infarction secondary to blunt chest trauma from an automobile airbag deployment. J Invasive Cardiol 18(1):E71–E73
Holanda MS, Domínguez MJ, López-Espadas F, López M, Díaz-Regañón J, Rodríguez-Borregán JC (2006) Cardiac contusion following blunt chest trauma. Eur J Emerg Med 13(6):373–376
Frazee RC, Mucha P, Farnell MB, et al. (1986) Objective evaluation of blunt cardiac trauma. J Trauma 26:510–520
Wisner DH, Reed WH, Riddick RS (1990) Suspected myocardial contusion: triage and indications for monitoring. Ann Surg 212:82–86
Parmley LF, Manion WC, Mattingly TW (1958) Nonpenetrating traumatic injury of the heart. Circulation 18:371–396
Kato K, Kushimoto S, Mashiko K, Henmi H, Yamamoto Y, Otsuka T (1994) Blunt traumatic rupture of the heart: an experience in Tokyo [discussion]. J Trauma Inj Infec Crit Care 36(6):859–864
Schultz JM, Trunkey DD (2004) Blunt cardiac injury. Crit Care Clin 20:57–70
Kulshrestha P, Das B, Iyer KS, Sampath KA, Sharma ML, Rao IM, Venugopal P (1990) Cardiac injuries—a clinical and autopsy profile. J Trauma 30(2):203–207
Elie MC (2006) Blunt cardiac injuries. Mt Sinai J Med 73(2): 542–552
Feghali NT, Prisant LM (1995) Blunt myocardial injuries. Chest 108:1673–1677
Spodick DH (2003) Acute cardiac tamponade. N Eng J Med 349:684–690
Dalvi AN, Gondhalekar RA, Shirhatti RG, Joshi SV, Sukthankar RU, Mathur SK (1987) Atrial rupture following blunt chest trauma (a case report). J Postgrad Med 33:152
Cachecho R, Grindlinger GA, Lee VW (1992) The clinical significance of myocardial contusion [discussion]. J Trauma Inj Infec Crit Care 33(1):68–73
Van-Wijngaarden MH, Karmy-Jones R, Talwar MK, Simonetti V (1997) Blunt cardiac injury: a 10-year institutional review. Injury 28(1):51–55
Baxter BT, Moore EE, Moore FA, McCroskey BL, Ammons LA (1989) A plea for sensible management of myocardial contusion [discussion]. Am J Surg 158(6):557–562
Dowd MD, Krug S (1996) Pediatric blunt cardiac injury: epidemiology, clinical features, and diagnosis. Pediatric Emergency Medicine Collaborative Research Committee: Working Group on Blunt Cardiac Injury. J Trauma Inj Infec Crit Care 40(1):61–67
LoCicero III J, Mattox KL (1989) Epidemiology of chest trauma. Surg Clin North Am 69(1):15–19
Santavirta S, Arajarvi E (1992) Ruptures of the heart in seatbelt wearers. J Trauma Inj Infec Crit Care 32(3): 275–279
Calhoon JH, Hoffmann TH, Trinkle JK, Harman PK, Grover FL (1986) Management of blunt rupture of the heart. J Trauma Inj Infec Crit Care 26(6):495–502
Roth T, Kipfer B, Takala J, Schmid RA (2002) Delayed heart perforation after blunt trauma. Eur J Cardiothorac Surg 21(1):121–123
Malangoni MA, McHenry CR, Jacobs DG (1994) Outcome of serious blunt cardiac injury [discussion]. Surgery 116(4): 628–633
Genoni M, Jenni R, Turina M (1997) Traumatic ventricular septal defect. Heart 78(3):316–318
Fulda G, Brathwaite CE, Rodriguez A, Turney SZ, Dunham CM and Cowley RA (1991) Blunt traumatic rupture of the heart and pericardium: a ten-year experience (1979–1989) [discussion]. J Trauma Inj Infec Crit Care 31(2):167–173
Doll D, Glapa M, Bonanno F, Smith MD, Düsel W, Degiannis E (2007) Traumatic rupture of the cardiac auricle after forceful blunt abdominal trauma. Unfallchirurg 110(7): 637–639
Ette HY, Guilbeau-Frugier C, Grill S, Delisle M, Telmon N, Rouge D (2006) Cardiac rupture following blunt chest trauma: The case of a high semi-truck. Int J Forensic Sci 1:2
Prêtre R, Chilcott M (1997) Blunt trauma to the heart and great vessels. N Engl J Med 27, 336(9):626–632
Schick EC Jr (1995) Nonpenetrating cardiac trauma. Cardiol Clin 13:241–247
Roxburgh JC (1996) Myocardial contusion. Injury 27: 603–605
Asencio JA, Gorcia-Nulez LM, Petrone P (2007) Trauma to the heart. Trauma, 6th edition, edited by Feliciano DV, Mattox ML, Moore EE. McGraw Hill Professional; 569–586
Pasquale NK, Clarke J (1998) Screening of blunt cardiac injury. The Eastern Association for the Surgery of Trauma. Available at: (http://www.east.org/tpg/chap2.pdf). Accessed April, 2009
Ginzburg E, Dygert J, Parra-Davila E, Lynn M, Almedia J, Mayor M (1988) Coronary artery stenting for occlusive dissection after blunt chest trauma. J Trauma 45:157–161
Paone RF, Peacock JB, Smith DL (1993) Diagnosis of myocardial contusion. South Med J 86(8):867–870
Healey MA, Brown R, Fleiszer D (1990) Blunt cardiac injury: is this diagnosis necessary? [erratum appears in J Trauma Inj Infec Crit Care 30(4):514]. J Trauma Inj Infec Crit Care 30(2):137–146
Foil MB, Mackersie RC, Furst SR, Davis JW, Swanson MS, Hoyt DB, et al. (1990) The asymptomatic patient with suspected myocardial contusion [discussion]. Am J Surg 160(6):638–643
Illig KA, Swierzewski MJ, Feliciano DV, et al. (1991) A rational screening and treatment strategy based on the electrocardiogram alone for suspected cardiac contusion. Am J Surg 162:537–544
Biffl WL, Moore FA, Moore EE, et al. (1994) Cardiac enzymes are irrelevant in the patient with suspected myocardial contusion. Am J Surg 168:523–528
Bruns DE, Emerson JC, Intemann S, Bertholf R, Hill KE Jr, Savory J (1981) Lactate dehydrogenase isoenzyme-1: changes during the first day after acute myocardial infarction. Clin Chem 27(11):1821–1823
Jablonsky G, Leung FY, Henderson AR (1985) Changes in the ratio of lactate dehydrogenase isoenzymes 1 and 2 during the first day after acute myocardial infarction. Clin Chem 31(10):1621–1624
Salim A, Velmahos GC, Jindal A, et al. (2001) Clinically significant blunt cardiac trauma: role of serum troponin levels combined with electrocardiographic findings. J Trauma 50(2):237–243
Bertinchant JP, Polge A, Mohty D, et al. (2000) Evaluation of incidence, clinical significance, and prognostic value of circulating cardiac troponin I and T elevation in hemodynamically stable patients with suspected myocardial contusion after blunt chest trauma. J Trauma 48(5):924–931
Adams III JE, Davila-Roman VG, Bessey PQ, et al. (1996) Improved detection of cardiac contusion with cardiac troponin I. Am Heart J 131(2):308–312
Velmahos G, Karaiskakis M, Salim A, et al. (2003) Normal electrocardiographyand serum troponin I levels preclude the presenceof clinically significant blunt cardiac injury. J Trauma 54:45–51
Kaye P, O’sullivan Í (2002) Myocardial contusion: emergency investigation and diagnosis. Emerg Med J 19:8–10
Garcia-Fernandez M, Lopez-Perez J, Perez-Castellano N, et al. (1998) Role of transesophageal echocardiography in the assessment of patients with blunt chest trauma: correlation of echocardiographic findings with the electrocardiogram and creatine kinase monoclonal antibody measurements. Am Heart J 135:476–481
Patel AN, Brennig C, Cotner J, et al. (2003) Successful diagnosis of penetrating cardiac injury using surgeon-performed sonography. Ann Thorac Surg 76(6):2043–2047
Rozycki GS, Feliciano DV, Schmidt JA, et al. (1996) The role of surgeon performed ultrasound in patients with possible cardiac wounds. Ann Surg 223(6):737–744
Rozycki GS, Feliciano DV, Oschner MG, et al. (1999) The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma 46(4):543–551
Nagy KK, Krosner SM, Roberts RR, et al. (2001) Determining which patients require evaluation for blunt cardiac injury following blunt chest trauma. World J Surg 25(1): 108–111
Chirillo F, Totis O, Cavarzerani A, et al. (1996) Usefulness of transthoracic and transesophageal echocardiography in recognition and management of cardiovascular injuries after blunt chest trauma. Heart 75:301–306
Yoon SJ, Kwon HM, Kim D, et al. (2003) Acute myocardial infarction caused by coronary artery dissection following blunt chest trauma. Yonesi Med J 44:736–739
Waller BF, Pinkerton CA, Slack JD (1992) Intra vascular ultrasound: a historical study of vessels during life. The new ‘gold standard’ for vascular imaging. Circulation 85: 2305–2310
Pia M (2006) Diagnosis of myocardial contusion after blunt chest trauma using 18F-FDG positron emission tomography. Br J Radiol 79:264–265
Alexánderson Rosas E, Lamothe Molina PA, Iñarra Talboy F, Calleja Torres R, Martínez García A, Ochoa López JM, Meave González A (2008) Value of the assessment of myocardial viability: evaluation with positron emission tomography 18F-FDG. Arch Cardiol Mex 78(4):431–437
Ghesani M, Depuey EG, Rozanski A (2005) Role of F-18 FDG positron emission tomography (PET) in the assessment of myocardial viability. Elctrocardiography 22(2): 165–177
Dellegrottaglie S, Pedrotti P, Pedretti S, Mauri F, Roghi A (2008) Persistent myocardial damage late after cardiac contusion: depiction by cardiac magnetic resonance. J Cardiovasc Med (Hagerstown) 9(11):1177–1179
Southam S, Jutila C, Ketai L (2006) Contrast-enhanced cardiac MRI in blunt chest trauma: differentiating cardiac contusion from acute peri-traumatic myocardial infarction. J Thorac Imaging 21:176–178
Potkin RT, Werner JA, Trobaugh GB, et al. (1982) Evaluation of noninvasive tests of cardiac damage in suspected cardiac contusion. Circulation 66:627–631
Sybrandy KC, Cramer MJM, Burgersdijk C (2003) Diagnosing cardiac contusion: old wisdom and new insights. Heart 89:485–489
He YM, Yang XJ, Wu YW, Zhang B (2009) Twenty-fourhour thallium-201 imaging enhances the detection of myocardial ischemia and viability after myocardial infarction: a comparison study with echocardiography follow-up. Clin Nucl Med 34(2):65–69
Getz BS, Davies E, Steinberg SM (1986) Blunt cardiac trauma resulting in right atrial rupture. JAMA 255:761–763
Robert JR (2004) Roberts’ clinical procedures in emergency medicine: concepts and clinical practice. 4th ed. Elsevier, New York
Cachecho R, Grindlinger GA, Lee VW (1992) The clinical significance of myocardial contusion. J Trauma 33:68–73
Maenza RL, Seaberg D, D’Amico F (1996) A meta-analysis of blunt cardiac trauma: ending myocardial confusion. Am J Emerg Med 14(3):237–241
Wall MJ Jr, Mattox KL, Chen CD, Baldwin JC (1997) Acute management of complex cardiac injuries. J Trauma 42(5): 905–912
Christensen MA, Sutton KR (1993) Myocardial contusion: new concepts in diagnosis and management. Am J Crit Care 2:28–34
Dalvi AN, Gondhalekar RA, Shirhatti RG, Joshi SV, Sukthankar RU, Mathur SK (1987) Atrial rupture following blunt chest trauma (a case report). J Postgrad Med 33: 152
Silver GM, Spampinato N, Favaloro RG, Groves LK (1973) Ventricular aneurysms and blunt chest trauma. Chest 63(4): 628–631
Brown DL, Ivey TD (1996) Giant organized pericardial hematoma producing constrictive pericarditis: a case report and review of the literature. J Trauma 41(3):558–560
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Agarwal, D., Chandra, S. Challenges in the diagnosis of blunt cardiac injuries. Indian J Surg 71, 245–253 (2009). https://doi.org/10.1007/s12262-009-0078-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12262-009-0078-4