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Myocardial contusion without creatine kinase--MB elevation
D W Unkle1, R Smejkal, K F O'Malley
1Division of Trauma and Emergency Medical Services, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, Camden 08103.
Insights
Myocardial contusion following chest trauma is complex to diagnose. This case highlights a myocardial contusion diagnosed during surgery, despite normal creatine kinase and creatine kinase MB levels.
Area of Science:
- Cardiology
- Trauma Surgery
- Biochemistry
Background:
- Myocardial contusion is a significant challenge in trauma care.
- Current diagnostic tools like ECG, echocardiography, and cardiac biomarkers (creatine kinase, CK-MB) lack definitive sensitivity and specificity.
- Accurate diagnosis is crucial for appropriate patient management and outcomes.
Observation:
- A case of intraoperatively confirmed myocardial contusion is presented.
- The patient presented with chest trauma, necessitating surgical intervention.
- Cardiac biomarker levels were monitored throughout the patient's care.
Findings:
- The intraoperative findings definitively proved myocardial contusion.
- Despite the confirmed myocardial contusion, serum levels of creatine kinase (CK) and its MB subfraction (CK-MB) remained within normal limits.
- This challenges the established role of these biomarkers in diagnosing myocardial contusion.
Implications:
- The findings suggest that creatine kinase and CK-MB may not be reliable indicators for diagnosing myocardial contusion in all cases.
- Further research is needed to identify more sensitive and specific diagnostic markers for myocardial contusion.
- This case underscores the importance of considering intraoperative assessment when traditional diagnostic methods are inconclusive.
Abstract:
Myocardial contusion after chest trauma remains one of the major complexities of trauma care today. Diagnostic methods such as 12-lead electrocardiography and echocardiography, as well as activity of the biochemical marker creatine kinase and the MB subfraction, have not been shown to be sensitive or specific indicators. We report a case of an intraoperatively proved myocardial contusion without creatinine kinase or creatine kinase MB elevation.