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[Heart contusions: pathological findings and clinical course]
C Attenhofer1, A Vuilliomenet, M Richter
1Medizinische Klinik, Stadtspital Triemli Zürich.
Insights
Myocardial contusion diagnosis after blunt chest trauma requires careful monitoring. Enzyme levels and ECGs are key, with echocardiography useful in select cases for diagnosing cardiac injury.
Area of Science:
- Cardiology
- Trauma Surgery
- Emergency Medicine
Context:
- Blunt chest trauma frequently leads to suspected myocardial contusion.
- Diagnostic criteria and monitoring guidelines for myocardial contusion are often unclear.
- This study reviews hospital records of patients with blunt chest trauma and myocardial contusion.
Purpose:
- To analyze laboratory, ECG, and echocardiography findings in myocardial contusion patients.
- To identify cardiac-related complications and associated injuries.
- To recommend diagnostic and monitoring protocols for myocardial contusion.
Summary:
- Retrospective review of 50 patients with myocardial contusion post-blunt chest trauma.
- Abnormal enzyme levels (CPK-MB, LDH) were found in 90%, with rapid decline.
- ECG changes (ventricular tachycardia, ST/T changes, bundle branch block) occurred in 32%.
- Echocardiography revealed abnormalities in 37% (pericardial effusion, wall motion abnormalities, hematoma).
- One patient died of multiorgan failure; no sudden cardiac deaths.
Impact:
- Highlights the importance of diagnosing myocardial contusion in both stable and unstable patients.
- Recommends enzyme levels (CPK, CPK-MB) and ECG monitoring as a minimum diagnostic program.
- Suggests echocardiography may be necessary for further evaluation.
- Proposes 24-hour monitoring of ECG and hemodynamics, with no further monitoring needed if no complications arise.
Abstract:
After blunt chest trauma, myocardial contusion is frequently suspected, but diagnostic criteria are difficult to define and commonly accepted recommendations for duration and form of patient monitoring are lacking. We therefore conducted a retrospective review of the hospital records of 50 consecutively hospitalized patients with the diagnosis of myocardial contusion after blunt chest trauma, and analyzed the pathological laboratory, ECG and echocardiography findings as well as the associated injuries and cardiac-related complications. The average injury severity score was 25 +/- 8. Initially 98% of the patients were hemodynamically stable. In 90% there were abnormal enzyme levels consistent with myocardial injury. Typically, the maximum level of CPK-MB, LDH and CPK-MB/CPK (MB-fraction) was found initially and these values declined rapidly. The MB fraction normalized within 8 hours. In 32% of the patients there were the following ECG changes consistent with myocardial contusion transient: ventricular tachycardia (12%), ST/T changes (12%), complete right bundle branch block (10%), atrial fibrillation (4%), first degree AV block (2%). The episodes of ventricular tachycardia were registered within the first 24 hours; in 5 of these 6 patients the admission ECG was normal. An echocardiography was done in 64% of the patients and in 37% showed either a pericardial effusion, regional wall motion abnormalities, a pneumopericardium or an intramyocardial hematoma in the free wall of the right ventricle. One patient died of multiorgan failure during this hospitalization. There were no sudden cardiac deaths. The diagnosis of myocardial contusion is vital in unstable patients but also very important in hemodynamically stable patients, despite its low morbidity. The minimum program we recommend for diagnosis and monitoring should include enzyme levels (CPK, CPK-MB) and ECG controls. Echocardiography may be necessary as well. If during the initial compulsory 24 hour monitoring of ECG and hemodynamics no complications occur, further monitoring is not necessary.