Myocardial Contusion Research Articles

Traumatic blunt cardiac injuries: An updated narrative review.

Blunt cardiac injury (BCI) is defined as injuries sustained due to blunt trauma to the heart, and it remains unchanged for long time. The spectrum of BCI ranges from a minor “bruise” to specific postcontusion cardiac conditions such as free-wall rupture. This is a narrative review provides a continued and updates details regarding BCIs from 2008 to 2017. For this purpose, a narrative review of literature was conducted using appropriate database for retrieval of articles through systematic search methodology. Autopsy-based studies are very limited. It can be concluded that regardless of the variability in the spectrum of modalities and medical/surgical resources, BCIs diagnosis and management remain a puzzle and needs further prospective studies.

Examination of hemodynamics in patients in hemorrhagic shock undergoing Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA)

BackgroundThe objective of this study was to investigate the hemodynamic effects of aortic occlusion (AO) during Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) using a sophisticated continuous vital sign (CVS) monitoring tool. MethodsPatients admitted between February 2013 and May 2017 at a tertiary center that received REBOA were included. Patients in cardiac arrest before or at the time of REBOA were excluded. Time of AO was documented by time-stamped videography and correlated with CVS data. Results28 patients were included, mean (standard deviation) ISS was 38 (11). 18 received Zone 1 (distal thoracic aorta) and 10 received Zone 3 (distal abdominal aorta) AO. Among Zone 1 patients the pre-AO systolic blood pressure (SBP) nadir was 64 (19) mmHg, which increased to a mean of 124 (29) mmHg within 5 min after AO (p < 0.01). Among Zone 3 patients the pre-AO SBP nadir was 75 (19) mmHg, which increased to a mean of 98 (14) mmHg within 5 min after AO (p < 0.01). 72% of Zone 1 patients had episodes during AO where SBP was less than 90 mmHg as compared to 80% of Zone 3 patients (p = 0.51). 100% of Zone 1 patients had periods during AO where SBP was greater than 140 mmHg as compared to 70% Zone 3 patients (p = 0.04). The overall mean decrease in SBP after balloon deflation was 13 (20) mmHg (p < 0.01), with similar decreases among groups (14 (21) mmHg vs 12 (18) mmHg for Zone 1 and 3 patients, respectively (p = 0.85)). Patients undergoing Zone 1 AO were more likely to have an acute change (increase or decrease) in their heart rate immediately after AO as compared to Zone 3 AO (p = 0.048). ConclusionsSignificant hemodynamic alterations occur before, during, and after AO. The effects of Zone 1 AO on blood pressure and heart rate appear different than Zone 3 AO. This may have important implications for cardiac or cerebral function and perfusion goals, particularly with concomitant injuries such as cardiac contusion or traumatic brain injury.

Creatine phosphokinase: the functioning and diagnostic capabilities of detecting myocardial contusion in patients with combined trauma

The purpose of the investigation was to study the activity of the general and myocardial fractions of CPK in the victims with a combined trauma, one of the components of which was a blunt trauma of the thorax, during the diagnosis of myocardial contusion. The study included 50 patients with combined trauma. Myocardial contusion diagnosed in 34 patients. In 16 cases, the diagnosis of traumatic heart damage has not confirmed. The diagnosis of heart contusion based on the definition of the mechanism of trauma, the results of electrocardiographic and echocardiographic studies, and the determination of blood troponin I in blood plasma in high concentrations. The indices of central hemodynamics and the activity of the general and myocardial fractions of CPK studied. It is determined that in patients with combined trauma the activity of the general CPK is extremely high due to damage to skeletal muscles and manifestations of shock. In the conditions of increasing the activity of the total CPK, there is a regular increase in activity in the blood of myocardial CPK, which does not matter for the diagnosis of myocardial contusion. A powerful link between the shock index and the value of the total activity of CPK in the blood, as well as the activity of CPK and other indices of central hemodynamics characterizing the severity of the shock revealed. Activity of myocardial CPK in the presence of a heart contusion against the background of polytrauma is usually higher than in patients without traumatic myocardial injury, but the correct interpretation of the indicator is very difficult due to the release of a small part of myocardial CPK from damaged skeletal muscles. One of the promising areas for improving the diagnosis of myocardial contusion in patients with polytrauma is the percentage of activity of myocardial CPK relative to the total activity of CPK. The diagnosis of myocardial contusion becomes quite possible when the activity of myocardial CPK exceeds the 4% activity of the total CPK.

Atrial Fibrillation due to Blunt Cardiac Injury: Case Report

Atrial Fibrillation due to Blunt Cardiac Injury: Case Report

The Depth of Sternal Fracture Displacement Is Not Associated With Blunt Cardiac Injury

Background: Little evidence exist associating displaced sternal fractures with blunt cardiac injury (BCI), especially regarding the depth and severity of sternal fracture displacement and risk of BCI. The purpose of this study was to quantify sternal fracture severity by the degree of displacement and to evaluate the association of fracture severity with BCI. Materials and methodsA single institution retrospective review was performed from 2011 to 2014. All adult patients with sternal fracture were identified from the trauma registry, and sternal fracture displacement was quantified as mild (>0 mm, <5 mm), moderate (≥5 mm, <10 mm), or severe (≥10 mm). BCI was diagnosed according to standard AAST grading. Analysis was performed to assess the association of sternal fracture displacement with BCI, which was the primary outcome of interest. ResultsTwo hundred thirty-five patients with sternal fractures were included in the study. Forty-five percentage of patients suffered a displaced fracture, and 42.6% were diagnosed with BCI. There was no difference in mean fracture displacement when compared to patients without BCI (2.4 versus 1.6 mm, P = 0.07). There was no significant increase in BCI with sternal fracture displacement when compared to patients with nondisplaced fractures (44.3% versus 41.1%, P = 0.62). Neither fracture displacement (OR 1.10, CI 95% 0.65-1.88) nor severe displacement (OR 2.34, CI 95% 0.64-8.54) was associated with significantly increased risk of BCI. ConclusionsThere is no significant association between the depth of sternal fracture displacement and BCI. Further evaluation and management for BCI should be reserved in the absence of additional symptoms or findings.

Forensic Pathological Identification and Antidiastole of Commotio Cordis.

Commotio cordis （CC） is the acute death caused by the cardiac rhythm disorder after a sudden blunt external force to the precordium of a healthy person without previous heart disease. As one type of violent heart damage, CC is rare with relatively small external force and sudden death, therefore causing disputes. This paper reviews the epidemiology, mechanisms and the key points in forensic identification of CC, discusses the identification and antidiastole of CC, myocardial contusion, sudden cardiac death and death from inhibition, and provides assistance to forensic pathologists to identify such causes of death.

Value the Journey.

Value the Journey.

Pediatric sternal fractures from a Level 1 trauma center

Background/purposeSternal fractures are rare in children. The purpose of this series is to document traumatic findings in pediatric patients with sternal fractures at a Level 1 trauma center. Study designWe reviewed the charts of patients with radiologically confirmed sternal fractures from a trauma database at a pediatric Level 1 trauma center between January 1, 2000 and December 31, 2015. We report mechanisms of injury, associated injuries, complications, and outcomes associated with sternal fractures. ResultsOver the 16-year period, 19/25,781 (0.07%) admitted patients had radiologically confirmed sternal fractures. 15/19 (78.9%) patients were male. The median age was 14 years, with interquartile range 10–16 years. 7/19, (36.8%) were sustained owing to motor vehicle accidents. Associated injuries included substernal hematoma (n = 6), pulmonary contusion (n = 4), vertebral injury (n = 2), rib fracture (n = 4), intraabdominal injury (n = 3), pneumothorax (n = 3), long bone injury (n = 3) traumatic brain injury (n = 2), hemothorax (n = 2), pneumomediastinum (n = 2) and cardiac contusion (n = 1). ConclusionsIn this series, pediatric sternal fractures were caused by high velocity mechanisms and had significant comorbidity. While patients with isolated sternal fractures may be candidates for emergency department discharge, a thorough evaluation should be performed in children with sternal fractures to identify concurrent injuries. Level of evidenceLevel IV.

National risk factors for blunt cardiac injury: Hemopneumothorax is the strongest predictor

BackgroundBlunt cardiac injury (BCI) can occur after chest trauma and may be associated with sternal fracture (SF). We hypothesized that injuries demonstrating a higher transmission of force to the thorax, such as thoracic aortic injury (TAI), would have a higher association with BCI. MethodsWe queried the National Trauma Data Bank (NTDB) from 2007-2015 to identify adult blunt trauma patients. ResultsBCI occurred in 15,976 patients (0.3%). SF had a higher association with BCI (OR = 5.52, CI = 5.32–5.73, p < 0.001) compared to TAI (OR = 4.82, CI = 4.50–5.17, p < 0.001). However, the strongest independent predictor was hemopneumothorax (OR = 9.53, CI = 7.80–11.65, p < 0.001) followed by SF and esophageal injury (OR = 5.47, CI = 4.05–7.40, p < 0.001). ConclusionSF after blunt trauma is more strongly associated with BCI compared to TAI. However, hemopneumothorax is the strongest predictor of BCI. We propose all patients presenting after blunt chest trauma with high-risk features including hemopneumothorax, sternal fracture, esophagus injury, and TAI be screened for BCI. SummaryUsing the National Trauma Data Bank, sternal fracture is more strongly associated with blunt cardiac injury than blunt thoracic aortic injury. However, hemopneumothorax was the strongest predictor.

Cardiac Injuries at Estonian Major Trauma Facilities: A 23-year Perspective.

Cardiac injuries are highly lethal lesions following trauma and most of the patients decease in pre-hospital settings. However, studies on cardiac trauma in Estonia are scarce. Thus, we set out to study cardiac injuries admitted to Estonian major trauma facilities during 23 years of Estonian independence. After the ethics review board approval, all consecutive patients with cardiac injuries per ICD-9 (861.0 and 861.1) and ICD-10 codes (S.26) admitted to the major trauma facilities between 1 January 1993 and 31 July 2016 were retrospectively reviewed. Cardiac contusions were excluded. Data collected included demographics, injury profile, and in-hospital outcomes. Primary outcome was mortality. Secondary outcomes were cardiac injury profile and hospital length of stay. During the study period, 37 patients were included. Mean age was 33.1 ± 12.0 years and 92% were male. Penetrating and blunt trauma accounted for 89% and 11% of the cases, respectively. Thoracotomy and sternotomy rates for cardiac repair were 80% and 20%, respectively. Most frequently injured cardiac chamber was left ventricle at 49% followed by right ventricle, right atrium, and left atrium at 34%, 17%, and 3% of the patients, respectively. Multi-chamber injury was observed at 5% of the cases. Overall hospital length of stay was 13.5 ± 16.7 days. Overall mortality was 22% (n = 8) with uniformly fatal outcomes following left atrial and multi-chamber injuries. Overall, 37 patients with cardiac injuries were hospitalized to national major trauma facilities during the 23-year study period. The overall in-hospital mortality was 22% comparing favorably with previous reports. Risk factors for mortality were initial Glasgow Coma Scale < 9, pre-hospital cardiopulmonary resuscitation, and alcohol intoxication.

Flail Chest: Less Deadly than Originally Thought.

Flail chest is considered a highly morbid condition with reported mortality ranging from 10 to 20%. It is often associated with other severe injuries, which may complicate management and interpretation of outcomes. The physiologic impact and prognosis of isolated flail chest injury is poorly defined. This is a National Trauma Databank study. All patients from 1/2007 to 12/2014 admitted with flail chest were extracted. Patients with head or abdominal AIS ≥3, dead on arrival, or transferred, were excluded. Primary outcome was mortality; secondary outcomes were need for mechanical ventilation and pneumonia. Of the 1,047,519 patients with blunt chest injury, 14,718 (1.4%) patients presented with flail chest, and 8098 (0.77%) met inclusion criteria. The most commonly associated intrathoracic injuries were hemothorax (57.9%) and lung contusions (63.0%), while sternal fracture (8.8%) and cardiac contusion (2.5%) were less common. In total, 29.8% of patients required mechanical ventilation, and 11.2% developed pneumonia. Overall mortality was 5.6%. On multivariable analysis, age >65 and need for mechanical ventilation were independent risk factors for mortality (OR 6.02, 3.75, respectively, p < 0.001). Independent predictors for mechanical ventilation included cardiac or pulmonary contusion and sternal fractures (OR 3.78, 2.38, 2.29, respectively, p < 0.001). Need for mechanical ventilation was an independent predictor of pneumonia (OR 13.18, p < 0.001). Mortality in isolated flail chest is much lower than previously reported. Fewer than 30% of patients require mechanical ventilation. Need for mechanical ventilation, however, is independently associated with mortality and pneumonia. Age >65 is an independent risk factor for adverse outcomes, and these patients may benefit by more aggressive monitoring and treatment.

Case reports of atrial and pericardial rupture from blunt cardiac trauma

BackgroundBlunt cardiac trauma is diagnosed in less than 10% of trauma patients and covers the range of severity from clinically insignificant myocardial contusions to lethal multi-chamber cardiac rupture. The most common mechanisms of injury include: motor vehicle collisions (MVC), pedestrians struck by motor vehicles and falls from significant heights. A severe complication from blunt cardiac trauma is cardiac chamber rupture with pericardial tear. It is an exceedingly rare diagnosis. A retrospective review identified only 0.002% of all trauma patients presented with this condition. Most patients with atrial rupture do not survive transport to the hospital and upon arrival diagnosis remains difficult.Case presentationWe present two cases of atrial and pericardial rupture. The first case is a 33-year-old female involved in a MVC, who presented unresponsive, hypotensive and tachycardic. A left sided hemothorax was diagnosed and a chest tube placed with 1200 mL of bloody output. The patient was taken to the OR emergently. Intraoperatively, a laceration in the right pericardium and a 3 cm defect in the anterior, right atrium were identified. Despite measures to control hemorrhage and resuscitate the patient, the patient did not survive.The second case is a 58-year-old male involved in a high-speed MVC. Similar to the first case, the patient presented unresponsive, hypotensive and tachycardic with a left sided hemothorax. A chest tube was placed with 900 mL of bloody output. Based on the output and ongoing resuscitation requirements, the patient was taken to the OR. Intraoperatively, a 15 cm anterior pericardial laceration was identified. Through the defect, there was brisk bleeding from a 1 cm laceration on the left atrial appendage. The injury was debrided and repaired using a running 3–0 polypropylene suture over a Satinsky clamp. The patient eventually recovered and was discharged home.ConclusionsWe present two cases of uncontained atrial and pericardial rupture from blunt cardiac trauma. Contained ruptures with an intact pericardium present as a cardiac tamponade while uncontained ruptures present with hemomediastinum or hemothorax. A high degree of suspicion is required to rapidly diagnose and perform the cardiorrhaphy to offer the best chance at survival.

Blunt rupture of the thoracic duct after severe thoracic trauma

A 53-year-old man was admitted to our trauma center after sustaining thoracoabdominal injuries, secondary to a rear-end motor vehicle collision. As he stepped out of his vehicle, he was struck...

Pediatric Cardiac Trauma in the United States: A Systematic Review.

Literature discussing cardiac injuries in children is limited. Systematic search of PubMed identified 21 studies enrolling 1,062 pediatric patients who experienced cardiac trauma in the United States during the period 1961 to 2012. The predominant type of injury was blunt cardiac contusion affecting 59.7% (n = 634/1,062) of the study population. Motor vehicle crashes (53.5%, n = 391/731) were the leading cause of blunt cardiac trauma, while gunshot wounds (50%, n = 150/300) accounted for most penetrating injuries. Overall mortality rate was 35.2% (n = 374/1,062).

Thoracic Injuries and Management Options

Thoracic trauma accounts for nearly 25% of deaths secondary to blunt trauma. The most common chest injury is a rib fracture, which can be associated with a mortality risk as high as 35%. Other injuries include pneumothorax, hemothorax, esophageal injury, aortic transection, blunt cardiac injury, tracheobronchial disruption, and pulmonary contusion. The majority of thoracic injuries can be treated successfully with either observation or tube thoracostomy and general supportive care alone. Independent contributors to mortality include inadequate pain control, poor pulmonary hygiene, failure to intubate appropriately, and excessive crystalloid-based resuscitation. This review contains 3 figures, 5 tables and 64 references Key words: aorta, bronchus, esophagus, hemothorax, pneumothorax, pulmonary contusion, rib fracture, thoracic, trachea, tracheobronchial

Dissection of the interventricular septum after compressive blunt chest trauma

We report the case of a 21-year-old woman who was referred after a severe compressive blunt trauma in the context of job injury. Myocardial contusion is a common injury; however, rupture of the ventricular septum after blunt chest trauma is a rare event. Echocardiography revealed a large ventricular septal rupture with two small ventricular septal defects. The patient was a candidate for surgical repair after early conservative management. We discuss about the prevalence and management of this rare traumatic complication.

Concussion of an athlete ́s heart – a case report of blunt chest trauma associated loss of consciousness in a professional soccer player (RCD code: V-4O)

We present a case of cardiac concussion (commotio cordis) resulting from blunt chest trauma injury in a professional athlete. The soccer player received frontal injury to the chest caused by another player’s knee during a training session. A few minutes of spontaneously relapsing unconsciousness ensued and the patient was admitted urgently for observation. Surface electrocardiogram showed dynamic alterations in the precordial leads, cardiac necrotic markers were only mildly elevated and cardiac magnetic resonance could not detect any injury‐related pathology. The athlete received conservative treatment. We discuss the differential diagnosis with cardiac contusion and Brugada syndrome. Electrocardiographic abnormalities persisted during the two‐week follow‐up. The patient successfully continues his professional soccer career. JRCD 2017; 3 (5): 171–175

Emergency Surgical Management of Traumatic Cardiac Injury in Single Institution for Three Years

Purpose: Thoracic traumas represent 10-15% of all traumas and are responsible for 25% of all trauma mortalities. Traumatic cardiac injury (TCI) is one of the major caus es of death in trauma patients, rarely present in living patients who are transferred to the hospital. TCI is a challenge for trauma surgeons as it provides a short therapeutic window and the management is often dictated by the underlying mechanism and he modynamic status. This study is to describe our experiences about emergency cardiac surgery in TCI. Methods: This is a retrospective clinical analysis of patients who had undergone emer gency cardiac surgery in our trauma center from January 2014 to December 2016. Demo graphics, physiologic data, mechanism of injuries, the timing of surgical interventions, surgical approaches and outcomes were reviewed. Results: The number of trauma patients who arrived at our hospital during the study period was 9,501. Among them, 884 had chest injuries, 434 patients were evaluated to have over 3 abbreviated injury scale (AIS) about the chest. Cardiac surgeries were per formed in 18 patients, and 13 (72.2%) of them were male. The median age was 47.0 years (quartiles 35.0, 55.3). Eleven patients (61.1%) had penetrating traumas. Prehospital car diopulmonary resuscitations (CPR) were performed in 4 patients (22.2%). All of them had undergone emergency department thoracotomy (EDT), and they were transferred to the operating room for definitive repair of the cardiac injury, but all of them expired in the intensive care unit. Most commonly performed surgical incision was median sternotomy (n=13, 72.2%). The majority site of injury was right ventricle (n=11, 61.1%). The mortality rate was 22.2% (n=4). Conclusions: This study suggests that penetrating cardiac injuries are more often than blunt cardiac injury in TCI, and the majority site of injury is right ventricle. Also, it sug gests prehospital CPR and EDT are significantly responsible for high mortality in TCI.

Safety and effectiveness of transcatheter embolization in the treatment of internal mammary artery injuries.

Demonstrate the role of endovascular management in the treatment of internal mammary artery (IMA) injuries using transcatheter embolization reviewing our 7-year experience. Our retrospective analysis of cases consists of a total of 12 patients (8M and 4F; mean age 52years) who underwent angiographic studies and transcatheter embolization for IMA injuries. Causes of vascular injury were divided in high-energy trauma (n=6), iatrogenic (n=3) and penetrating injuries (n=3). Type of trauma, associated injury, imaging findings, treatments and complications were assessed. Imaging findings included active haemorrhage, pseudoaneurysm and focal dissection. Embolization was performed with microcoils in all patients; complete thrombosis was obtained in four patients by additional injection of Spongostan pledgets and in two patients with 300-500μm particles. The technical success rate was 100%. No patient died as a direct result of vascular injury; one died of myocardial contusion and one for severe multiorgan failure related to high-energy trauma. No major and minor complications were registered. No patient required emergency surgery or subsequent surgical treatment. Transcatheter embolization offers an effective, efficient and safe alternative to conventional surgical management of IMA injuries.

EXPERIMENTAL SIMULATION OF HEART CONTUSION

The study presents the data of experimental simulation of heart contusion on laboratory animals of a various degree of severity. Conclusions are drawn, that as a result of closed chest injury, associated with heart contusion, various variants of the heart activity occur, similarly to those occuring in case of contusion damages of the heart of victims with the specified severe type of the injury which is evidenced by electrocardiography examinations.