Frequency of myocardial injury after blunt chest trauma as evaluated by radionuclide angiography

doi:10.1016/0002-9149(83)90540-4

The American Journal of Cardiology

Volume 52, Issue 8, 1 November 1983, Pages 1099-1103

https://doi.org/10.1016/0002-9149(83)90540-4 Get rights and content

Abstract

Seventy-seven patients who had sustained multisystem trauma, including severe blunt chest injury, were prospectively evaluated to assess the frequency of associated traumatic myocardial injury. Traumatic injury to either the right or left ventricle was defined by the presence of discrete abnormalities of wall motion on electrocardiographically gated cardiac scintigraphy in patients without a clinical history of heart disease. Forty-two patients (55%) (Group 1) had focal abnormalities of wall motion; 27 involved the right ventricle, 7 the left ventricle, 7 were biventricular, and 1 involved only the septum. Both the right and left ventricular ejection fractions were significantly (p < 0.01) lower (31 ± 11% and 47 ± 14%, respectively) than those in the 35 traumatized patients without wall motion abnormalities on scintigraphy (Group 2) (49 ± 8% and 58 ± 11%, respectively). Repeat scintigraphic examination in 32 Group 1 patients at a time remote from initial injury showed improvement or resolution of previously defined focal wall motion abnormalities in 27 of 32 patients (84%). The electrocardiogram and serum enzyme tests were insensitive indexes of traumatic myocardial injury when defined by the scintigraphic abnormalities. Thus, severe blunt chest trauma results in a higher frequency of traumatic myocardial injury than heretofore recognized, and frequently involves the anteriorly situated right ventricle.

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Cited by (69)

Cardiac contusions in the acute care setting: Historical background, evaluation and management
2022, American Journal of Emergency Medicine
Citation Excerpt :
Another common cause of cardiac contusion after blunt chest trauma is the compression of the heart between the sternum and the vertebral column related to direct, high-velocity blows to the chest wall, which can reduce the anteroposterior thoracic diameter by up to 50%, depending on the intensity of the forces acting on the thoracic wall [5,6]. Finally, cardiac contusions can also result from an overload of intraventricular volume and pressure, related to an upward displacement of abdominal viscera or caused by the hydraulic effects of increased venous return following crush injuries [7,8]. A wide range of clinical manifestations characterizes subjects with cardiac contusions, on the basis of the type and extension of myocardial injury following blunt chest trauma.
Albeit described since 1763, cardiac contusions is still an under-recognised clinical condition in the acute care setting. This evidence-based review aims to provide an overview of the topic by focusing on etiopathogenesis, classification and clinical presentation of patients with cardiac contusions, as well as on the diagnostic work-up and therapy options available for this subset population in the acute care setting.
A targeted research strategy was performed using PubMed, MEDLINE, Embase and Cochrane Central databases up to June 2022. The literature search was conducted using the following keywords (in Title and/or Abstract): (“cardiac” OR “heart” OR “myocardial”) AND (“contusion”). All available high-quality resources written in English and containing information on epidemiology, etiopathogenesis, clinical findings, diagnosis and management of cardiac contusions were included in our research.
Biochemical samples of cardiac troponins together with a 12‑lead ECG appear to be sufficient screening tools in hemodynamically stable subjects, while cardiac ultrasound provides a further diagnostic clue for patients with hemodynamic instability or those more likely to have a significant cardiac contusion.
The management of patients with suspected cardiac contusion remains a challenge in clinical practice. For this kind of patients a comprehensive diagnostic approach and a prompt emergency response are required, taking into consideration the degree of severity and clinical impairment of associated traumatic injuries.
Myocardial Infarction Secondary to Blunt Chest Trauma
2018, American Journal of the Medical Sciences
Citation Excerpt :
Cardiovascular injuries following blunt chest trauma (BCT) were first described by Akenside10 in 1764. They are common and vary broadly in type and severity, with imaging and electrocardiographic (EKG) abnormalities being detected in more than half of BCT cases.11,12 Acute MI following BCT, however, is uncommon, but its burden is significant as it affects young, previously healthy individuals.13
Myocardial infarction (MI) following blunt chest trauma is rare, but potentially fatal. We treated a young patient for acute MI after falling chest-first on ice while playing hockey. Coronary artery bypass grafting (CABG) was performed after percutaneous stenting attempts were unsuccessful. By reviewing the related literature, we found 179 cases, the majority of which affected young males following road accidents. Left anterior descending artery was most frequently affected followed by right coronary artery particularly in their proximal thirds. Prior to the advent of emergent angioplasty for MI, conservative management was frequently pursued, whereas subsequently both stenting and CABG were performed as initial therapy. Several cases required CABG after the failure of stenting attempts. Trauma-associated MI is uncommon but should be suspected to be properly diagnosed and managed; the potential need for CABG requires that a cardiac surgeon be informed at the time of angiography to avoid possible delay in revascularization.
Initial Management and Resuscitation of Severe Chest Trauma
2012, Emergency Medicine Clinics of North America
Citation Excerpt :
The reported incidence of BCI in all blunt thoracic trauma patients ranges from 20% to 76%.108–111 It encompasses a wide spectrum of clinical manifestations, ranging from an asymptomatic myocardial bruise to cardiac rupture and death.112,113 Because the right heart rests closest to the anterior chest wall, it is the most frequently involved area to be injured.107,114
Pneumopericardium in blunt chest trauma after high-speed motor vehicle accidents
2005, American Journal of Emergency Medicine
Pneumopericardium is the presence of air in the pericardial space. In adults, it may be seen in the context with severe blunt chest trauma, pneumothorax, pneumoperitoneum, or other causes of pneumomediastinum. The diagnosis is made by computed tomography scan of the thorax and abdomen that allows the additional detection of concomitant injuries. Possible causes of the pneumopericardium such as tracheobronchial or oesophageal tears have to be excluded by bronchoscopy or esophagogastroduodenoscopy. Usually, pneumopericardium is self-limiting requiring no specific therapy. However, a continuous monitoring of the electrocardiography and the blood pressure is necessary at an intermediate care unit. Tension pneumopericardium causing a life-threatening cardiac tamponade requires an immediate pericardial aspiration, the subsequent pericardial drainage via a pericardial window or emergent open subxyphoid approach to the pericardium.
Blunt cardiac injury
2004, Critical Care Clinics
Blunt chest trauma producing acute myocardial infarction in a rugby player
2003, Lancet

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^☆: This study was supported in part by Grant PR-916 from the Ministry of Health, Ontario, Canada.

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Miscellaneous topicFrequency of myocardial injury after blunt chest trauma as evaluated by radionuclide angiography☆

Abstract

Dis Chest

Lancet

Chest

Am J Cardiol

Am J Cardiol

Cardiac contusion: a capricious syndrome

Ann Surg

Evaluation of non-invasive tests of cardiac damage in suspected cardiac contusion

Circulation

Evaluation of technetium scanning for myocardial contusion

J Trauma

Delayed or missed diagnosis of cardiac damage in blunt chest trauma

J Trauma

Nonpenetrating cardiac injuries: a collective review

Am Heart J

Prolongation of the QT interval with myocardial contusion

Heart Lung

Miscellaneous topic
Frequency of myocardial injury after blunt chest trauma as evaluated by radionuclide angiography☆