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[Heart contusions: pathological findings and clinical course]
C Attenhofer1, A Vuilliomenet, M Richter
1Medizinische Klinik, Stadtspital Triemli Zürich.
Schweizerische Medizinische Wochenschrift
|October 24, 1992
Summary
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.