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Cardiac Contusion

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Cardiac Contusion, Blunt Cardiac Injury, Blunt Myocardial Injury, Myocardial Contusion, Heart Contusion

  • See Also
  1. Cardiac Tamponade
  2. Blunt Chest Trauma
  3. Lung Contusion
  4. Hemothorax
  5. Pneumothorax
  6. Traumatic Aortic Disruption
  7. Diaphragmatic Rupture
  8. Esophageal Rupture
  9. Bronchial Tear
  10. Sternal Fracture
  11. Commotio Cordis
  • Causes
  1. Chest Traumatic Injury
  2. High speed injury (e.g. MVA)
  3. Sternal Fracture
  • History
  1. Severe injury mechanism
  2. Bent stearing wheel in a Motor Vehicle Accident
  • Symptoms
  1. Chest Pain
  • Signs
  1. Hypotension
  2. Anterior chest wall injury
  3. Sternal Fracture signs (tenderness, deformity)
    1. Isolated Sternal Fracture alone (even when displaced) is NOT associated with significant cardiac injury
    2. However, OTHER associated Chest Trauma may be associated with cardiac injury
  • Labs
  1. Serial Troponin levels
    1. Standard Troponin at 4-6 hours or High Sensitivity Troponin at 3 hours after injury
    2. Test Sensitivity for combined EKG and Troponin approaches 100%
    3. High Sensiitivity Troponin abnormal cut-offs for Cardiac Contusion are not well established
      1. Some studies use twice normal cutoff
    4. References
      1. Becker (2024) J Surg Res 300:150-6 +PMID: 38815513 [PubMed]
  • Diagnostics
  1. Telemetry monitoring
  2. Electrocardiogram (EKG) - obtain serial EKGs
    1. See EKG monitoring in Trauma
    2. Obtain in all patients with presentations at risk of Cardiac Contusion
    3. Changes occur typically in first 8-24 hours of injury and typically resolve spontaneously
    4. Findings
      1. Premature Ventricular Contractions (PVC)
      2. Premature atrial contracts (PACs)
      3. Unexplained Sinus Tachycardia
      4. New onset Atrial Fibrillation (most common Arrhythmia)
      5. New Right Bundle Branch Block
      6. ST Segment changes
        1. Myocardial Infarction may occur in blunt cardiac Trauma
  3. Advanced hemodynamic monitoring (if central access)
    1. Central Venous Pressure increased
  • Imaging
  1. FAST Exam
    1. Pericardial Effusion may be present
  2. Echocardiogram
    1. Wall motion abnormality
    2. Right Ventricle is most commonly injured chamber in Sternal Fracture
    3. Evaluate for valvular injury
  • Evaluation
  1. Normal Troponin, EKG, hemodynamic and cardiac monitoring without significant other Chest Injury
    1. Unlikely to have significant cardiac injury
    2. May be discharged home after 6 hour observation
  2. Abnormal Troponin, EKG hemodynamic or cardiac monitoring (esp. in displaced Sternal Fracture, other Chest Trauma)
    1. Complete full evaluation with Echocardiogram, telemetry, trauma Consultation
  • Differential Diagnosis
  1. See Blunt Chest Trauma
  2. See associated conditions below
  3. Rib Fracture
  • Associated Conditions
  1. See Blunt Chest Trauma
  2. Heart Injury
    1. Valve Rupture
    2. Coronary Artery Dissection
    3. Cardiac Chamber Rupture
    4. Cardiac Tamponade
    5. Commotio Cordis
  3. Other Chest Injury
    1. Lung Contusion
    2. Hemothorax
    3. Pneumothorax
    4. Traumatic Aortic Disruption
    5. Diaphragmatic Rupture
    6. Esophageal Rupture
    7. Bronchial Tear
    8. Flail Chest
  • Management
  1. ABC Management
  2. Manage Hypoxia, Hypotension and identified complications
  3. Consultation as indicated (esp. Unstable Patients)
    1. Cardiology
    2. Cardiothoracic surgery
  4. Indications for observation (24-48 hour)
    1. See Evaluation above
    2. Complications (see below) are most likely to present in the first 24-48 hours
    3. Telemetry monitoring
    4. Serial Troponin levels
  • Complications
  1. Cardiogenic failure
  2. Arrhythmia (including lethal, ventricular Arrhythmia)
  • References
  1. Dreis (2020) Crit Dec Emerg Med 34(7):3-21
  2. (2012) ATLS, ACOS, p. 105
  3. Killu and Sarani (2016) FCCS, p. 160-1
  4. Swaminathan and Petrosoniak (2025) EM:Rap, published 12/8/2025