Cardiac Injury

Blunt cardiac injury is not well understood and probably relatively rare, although published incidences range from 8 to 76% [El-Chami MF et al. J Emerg Med 35: 127, 2008]. Because of its relative rarity, other cause of hypotension and/or arrhythmia should be ruled out before aggressively pursuing a diagnosis of cardiac contusion.

EKG alone is not sensitive or specific, and CK-MB is not reliable if the liver, intestines or diaphragm are involved, as they often are. While highly specific, troponins T and I have poor sensitivity in the trauma setting. Transthoracic echocardiography can be difficult to attain in these patients, thus, if possible, transesophageal echocardiography may be the most sensitive and specific test in patients with high clinical suspicion for blunt cardiac trauma. [El-Chami MF et al. J Emerg Med 35: 127, 2008

Complicating its management is difficulty distinguishing it from more traditional means of myocardial injury/infarction, as well as the potential for the two disease processes to overlap (ex. frontal impact dislodging atheromatous plaques, leading to ischemia etc.).

Once diagnosed, blunt cardiac injury should be managed in the same manner as ischemic cardiac injury (oxygen, vasodilators, meticulous fluid status, adequate monitoring).

Penetrating cardiac injury (or ruptured blunt injury) is almost uniformly fatal, however if a patient does survive to triage, ED thoracotomy is required in order to relieve the tamponade, followed by immediate transition to the operating room.