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Diagnosing cardiac contusion: old wisdom and new insights
  1. K C Sybrandy1,
  2. M J M Cramer1,
  3. C Burgersdijk2
  1. 1Heart Lung Centre Utrecht, Department of Cardiology, University Medical Centre, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
  2. 2Department of Cardiology, Medical Centre Alkmaar, Wilhelminalaan 12, 1815 JD Alkmaar, Netherlands
  1. Correspondence to:
    Dr MJM Cramer, Heart Lung Centre Utrecht, University Medical Centre, Department of Non-invasive Cardiac Imaging. HP F02.351, PO 85500, 3508 GA Utrecht, Netherlands;
    m.j.m.cramer{at}hli.azu.nl

Abstract

Cardiac contusion is usually caused by blunt chest trauma and therefore is frequently suspected in patients involved in car or motorcycle accidents. The diagnosis of a myocardial contusion is difficult because of non-specific symptoms and the lack of an ideal test to detect myocardial damage. Cardiac contusion can cause life threatening arrhythmias and cardiac failure. Many diagnostic methods, such as ECG, biochemical cardiac markers, transthoracic and transoesophageal echocardiography, and radionuclide imaging studies, have been investigated to determine their use in predicting such complications. Recently, cardiac troponin I and T were found to be highly sensitive for myocardial injury. Troponin I and T have also proved to be useful in the stratification of patients at risk for complications. Nevertheless, diagnosis of a cardiac contusion and identification of patients at risk remain a challenge. In this review the current diagnostic tests will be discussed. Also, based on these diagnostic tests, a screening strategy containing data from the latest studies is presented, with the intention of detecting patients at risk.

  • cardiac contusion
  • blunt chest trauma
  • diagnostic protocol
  • CK, creatine kinase
  • CK-MB, cardiospecific MB isoenzyme of creatine kinase
  • TOE, transoesophageal echocardiography
  • SPECT, single photon emission computed tomography
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