Learning objectives

• Identify patients at risk for cardiac contusion
• Diagnose cardiac contusion
• Manage patients with (suspected) cardiac contusion

Definition & mechanisms

• Bruising or (microscopically small) hemorrhaging of the heart muscle
• Generally caused by blunt thoracic trauma: A decelerating force on the anterior side of the thorax

Signs and symptoms

• Mechanical injuries (e.g., rupture of atria or chordae)
• Arrhythmias (premature ventricular complexes, atrial fibrillation, ventricular fibrillation), most commonly within 24 h after trauma
• In the emergency department, many patients do not show symptoms of cardiac contusion after trauma, but severe arrhythmia or even cardiac arrest can occur within 72 h
• Patients with hemodynamic changes but without clear bleeding or cardiac tamponade are suspected of cardiac contusion 

Diagnosis

Diagnosis for cardiac contusion remains controversial, diagnostic tools include:

• ECG
• Echocardiography
• Measurement of cardiac biomarkers (troponin T, troponin I, CK-MB)

Management

• Determine the extent of trauma (ECG, ultrasound, cardiac biomarkers)
• Assess cardiac function and intracardiac volume
• ICU admission for monitoring
• Cardiogenic shock management:
  • Invasive angiography
  • Revascularization
  • Inotropes/vasopressors
  • Fluid resuscitation
  • Ventilation
  • Mechanical support 

Suggested reading

• Van Lieshout EMM, Verhofstad MHJ, Van Silfhout DJT, Dubois EA. Diagnostic approach for myocardial contusion: a retrospective evaluation of patient data and review of the literature. Eur J Trauma Emerg Surg. 2021;47(4):1259-1272.
• Thiele H, Ohman EM, Desch S, Eitel I, de Waha S. Management of cardiogenic shock. European Heart Journal. 2015;36(20):1223-30.