Blunt Cardiac Injury

Excerpt

The term “cardiac contusion” has been used to describe an injury to the heart after blunt chest trauma. Histologically, it is characterized by a contused myocardium with hemorrhagic infiltrate, localized necrosis, and edema. Findings are best confirmed during surgery or at autopsy. Clinically, blunt cardiac injury (BCI) is the preferred diagnosis term, as blunt chest trauma can result in a broad range of cardiac injuries. BCIs can be further described by specific injuries or observed dysfunction. Significant BCI usually occurs from high-impact trauma from motor vehicle accidents (50%), pedestrians struck by motor vehicles (35%), motorcycle crashes (9%), and falls from significant heights (6%). Diagnosing BCI can be challenging as there is no accepted gold standard diagnostic test. The diagnosis is fraught with further difficulty in the polytrauma patient. The reported incidence of cardiac injury following blunt chest trauma ranges from 8% to 76%, in large part due to a lack of standardized diagnostic criteria.

In the absence of severe arrhythmia and hemodynamic instability, the significance of BCI is sometimes called into question. In the setting of blunt trauma, a high clinical suspicion for BCI is required, and certain patients should be monitored for adverse sequelae since there are no pathognomonic clinical signs or symptoms that correlate with the risk of cardiac complications. Indeed, the sequelae of BCI are more important than its label.