C8. An Extremely Rare Case: Cardiac Contusion Presenting with an Atrioventricular Block, An Unfortunate Fall

Abstract

Abstract Background Blunt cardiac injury (BCI), also referred to cardiac contusion, is a known cause of myocardial injury. It is often challenging to diagnose in the absence of clear diagnostic criteria. The clinical manifestation ranges from none to fatal arrhythmias to cardiac wall rupture seen on post-mortem examination. Cardiac biomarkers and electrocardiograms are usually helpful in identifying cardiac trauma but are not necessarily abnormal in all cases. Case Illustration A 55-year-old male with no history of cardiac disease was brought to the emergency department after a motor vehicle collision resulted in chest wall injury. The patient was found to have left clavicle fracture, left costae II-VII fractures, and hematothorax followed by chest tube insertion. The patient had multiple episodes of complete heart block with junctional escape rhythm alternate with high degree 2:1 AV conduction, and sometimes became a normal sinus rhythm. A temporary pacemaker was inserted. After the patient underwent the ORIF procedure, cardiac rhythm revealed normal sinus rhythm and temporary pacemaker is removed. Discussion High-degree AV block has been reported in human studies following BCI, secondary to necrosis, inflammation, or fibrotic changes in the subendocardial tissue. 50% of patients reviewed in the literature had a recurrence or permanent complete heart block requiring pacemaker implantation and complete heart block secondary to BCI which was associated with a 20% mortality in the post-traumatic period. Our patient developed a fatal heart block in the early period which could have easily been missed.