Blunt Cardiac Injury

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June 1, 2017 by dailybolusoflr


By: Michael Ehmann


Definition 
 
Clinical spectrum of cardiac injury secondary to blunt trauma, which includes myocardial contusion, coronary artery or valve injury, epi/myocardial rupture.

Etiology
Motor vehicle collisions and pedestrians struck by motor vehicles are the most common. However, can also be seen in abdominal compression, falls, crush injuries, assault, and sports injuries. The right ventricle is the most commonly injured cardiac structure.

Epidemiology
Present in approximately 20% of all blunt thoracic trauma patients; with severe thoracic injury or poly-trauma, the incidence of blunt cardiac injury can reach up to 75%.

Prognosis
Limited studies in literature, however one year cardiac function in patients with blunt cardiac injury was equal to injury severity score matched controls.

ED Evaluation
No standard criteria for deciding for who to screen and is physician dependent. General approach is to evaluate all patients with significant blunt trauma to the anterior thorax. Keep in mind however that there is no association with any specific traumatic injury.

Disposition
Patients with new EKG changes and/or elevated troponins needs admission for telemetry. Keep in mind that arrhythmias, ischemic changes, and heart block all normally occur in the first twelve hours. A normal admission EKG and troponin has a negative predictive value of 100%.

References
Clancy K, et al. Journal of Trauma and Acute Care Surgery. 2012;73(5 Suppl 4):S301-6
Schultz JM, et al. Crit Care Clin. 2004;(20)1:57-70

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