Cardiac contusion and creatine kinase-MB: A pertinent case history and brief review of the utility of CK-MB

doi:10.1016/0009-9120(94)90020-5

Clinical Biochemistry

Volume 27, Issue 2, April 1994, Pages 105-111

https://doi.org/10.1016/0009-9120(94)90020-5 Get rights and content

Abstract

Cardiac contusion is defined as the myocardial cellular damage that can result from nonpenetrating chest trauma. However the noninvasive diagnosis of this lesion is problematic. Among the criteria suggested for the diagnosis of cardiac contusion is an elevation of serum levels of the heart-specific isoform of the enzyme creatine kinase (CK-MB). We present here the case of a patient who, on the basis of an initial elevation of CK-MB, was suspected of having cardiac contusion as a result of a motor vehicle accident. The patient was clinically stable and there were no other signs to support this diagnosis. Serial analyses showed a fall in total CK to below the upper limit of the reference interval but, as a percent of total activity, CK-MB was constantly slightly elevated (values 5.1–6.5%, upper limit of normal = 4%). At the same time the patient appeared to be improving clinically. The patient's status deteriorated suddenly and he eventually went to surgery where a large intramural haematoma and a left ventricular aneurysm were discovered. The significance of the elevations of serum CK-MB is discussed and a brief review of the literature is presented.

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Cited by (12)

Cardiac contusions in the acute care setting: Historical background, evaluation and management
2022, American Journal of Emergency Medicine
Citation Excerpt :
Creatine kinase (CK) is non-specifically increased in subjects with associated multiple traumatic muscular injuries. Similarly, also the MB isoform of CK (CK-MB) has been shown to increase after physical exercise or in subjects with inflammatory muscular disease or traumatic muscular lesions (particularly those involving the diaphragm and tongue, which are intrinsically rich in CK-MB and are frequently involved in deceleration traumas) [24,25]. However, although CK-MB was initially reported to provide an increased specificity for the detection of myocardial injuries in patients with multiple traumatic lesions, further studies have reported a low sensitivity and specificity of CK-MB for myocardial injury even in case of mild non-cardiac muscular lesions [26].
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.
Diverse morphological lesions and serious arrhythmias with hemodynamic insults occur in the early myocardial contusion due to blunt impact in dogs
2007, Forensic Science International
Citation Excerpt :
Serum Mb, CK-MB, troponin I and troponin T have been used as diagnostic biochemical markers for cardiac contusion or myocardial infarction clinically. Elevated serum Mb, CK-MB, and troponin I and troponin T were detected in patients with early myocardial infarction [34–38] or cardiac contusion [7,10,39–42]. In recent years, it is demonstrated that serum troponin I and troponin T are highly specific to myocardial injury, especially in the diagnosis of myocardial contusion as they are myocardial regulatory contractile proteins which are not found in skeletal muscles and are released into the circulation only after loss of membrane integrity in comparison with serum Mb and CK-MB [7,10,42].
To investigate the morphology and hemodynamics of the early myocardial contusion, an animal model of cardiac contusion was established by impact to the precordial region at sternum at velocity of 10.0 m/s with a mechanical elastic-cord propelled impactor in 19 dogs. The electrocardiogram and both the left and right intra-ventricular pressures were recorded continuously throughout the experiment. Histological and immunohistochemical examinations of myoglobin, creatine kinase-MB and fibrinogen were conducted. At the moment of impact, abrupt over-pressures within the left and right ventricles occurred with concomitant serious arrhythmias followed by variety of cardiac conduction disorders and depressed left and right ventricular systolic pressures during the observation times. Histologically, lesions of myocardial contusions were identified at subepicardial, myocardial or subendocardial layer as interstitial hemorrhage, disruption or coagulative necrosis as well as contraction band necrosis of the muscle fibers, which might be categorized into the hemorrhagic, necrotized and mixed forms. The three forms of lesions were found to exist independently, or co-existed in a heart. However, severity of the lesions varied greatly with different parts even within a heart. Intravascular thromboses were occasionally discovered post-impact. Immunohistochemically, loss of myoglobin and creatine kinase-MB from cardiac cells, and accumulation of fibrinogen at the cell membranes were detected 5 min post-impact. The intracellular accumulation of fibrinogen increased with extension of post-impact intervals. Our results indicate that diverse morphological lesions concomitant with hemodynamic compromise and serious, even fatal arrhythmias occur in the early myocardial contusion, and intravascular thromboses are occasionally produced, suggesting that traumatic myocardial ischemic lesion may be induced due to blunt impact to the precordial region.
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2021, European Journal of Trauma and Emergency Surgery
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2019, Revista Colombiana de Cirugia
Preoperative Assessment of the Acute Critically Ill Trauma Patient in the Emergency Department
2019, Operative Techniques and Recent Advances in Acute Care and Emergency Surgery
Diagnosing myocardial contusion after blunt chest trauma
2016, Journal of Tehran University Heart Center

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Cardiac contusion and creatine kinase-MB: A pertinent case history and brief review of the utility of CK-MB

Abstract

J Emerg Med

Ann Emerg Med

Ann Thorac Surg

Am J Surg

J Surg Res

Am J Surg

Am J Surg

Chest

J Ped Surg

J Ped Surg

Ann Emerg Med

J Ped Surg

Am Heart J

The spectrum of myocardial contusion: A review

J Trauma

Blunt chest trauma

Emerg Med Clin NA