Cardiac contusion resulting from blunt chest trauma.

Abstract

A n 18-year-old high school senior was returning home late one afternoon from visiting a prospective college campus. While driving down a rural highway, he swerved to avoid a horse and rider who suddenly appeared from a side lane. His car left the road at a speed of about 40 mph and struck a tree. The young man was brought to a nearby hospital by the local sheriff for evaluation of possible injuries. On admission to the emergency department, he was alert and oriented and denied loss of consciousness. He was able to recall the accident and events prior to its occurrence. His main concern at that time was the amount of damage to the family car and what his parents would say about it. He repeatedly reassured the ED personnel that “I’m really all right. I need to get home as soon as my dad can come to get me.” Admission vital signs were as follows: blood pressure, 118/70 mm Hg; pulse, 108 beats/min; respirations, 16/min. There were no bony or soft tissue injuries other than minor abrasions of the left forearm. The only subjective complaint that could be elicted from this patient was one of substernal chest pain; he reported hitting his chest against the steering wheel on impact. Cardiac inspection, palpation, and auscultation revealed no abnormalities. Chest and sternal x-ray films were normal. A 1Zlead EKG revealed sinus tachycardia with minimal ST-segment elevation (less than 2 mm) in the anterior and lateral leads. Cardiac enzyme values were not obtained. The patient was discharged with a prescription for a mild analgesic and instructions to see his physician if chest pain did not abate within a few days. Several months later this young man reported to preseason football practice. During workouts in the hot August afternoons, he noted an increased shortness of breath and periods of dizziness. One day while running play patterns, he experienced a syncopal episode and was referred to the student health agency for evaluation. He agreed to obtain a com-