Blunt Cardiac Injury
OVERVIEW
Blunt Cardiac Injury: spectrum from asymptomatic with minor enzyme rises to fulminant cardiac failure
INJURIES
Cardiac injury
- 90% are lethal within minutes
- direct impact or pressure transmitted fixed and mobile parts (atriocaval disruptions)
Pericardial injury
- direct thoracic injury or indirect from acute increase in intra-abdominal pressure
- can cause significant herniation of through tear and cardiac dysfunction
Valvular injury
- aortic > mitral > tricuspid > pulmonary
- sudden increase in intrathoracic pressure -> laceration or avulsion of aortic cusps
- violent compression of heart in systole -> tearing of mitral valve leaflets and papillary muscle rupture
Septal injury
- rupture causes a loud holosystolic murmur or conduction abnormalities
Coronary artery injury
- rare
- cause dissection and thrombosis
- LAD most susceptible
- angioplasty / stent is the treatment of choice
Myocardial Contusion
- look for chest pain, pericardial rub, S3, cardiac failure
- ECG: ST or T wave changes anteriorly, heart blocks, incomplete RBBB, inferior Q waves
- ECHO: contractility, RWMA
- TNT elevation
HISTORY
- mechanism
- restrained
- airbags
- other injuries: sternal fractures, major chest wall injury (flail segment, haemopnemothorax, aortic injury)
- comorbidities: IHD, cardiomyopathy, pacemaker, AICD
- medications: beta-blockers, anti-arrhythmics
EXAMINATION
- observations: P, BP, SpO2, GCS
- CVS: peripheral perfusion, JVP, heart sounds (muffled, S3, rub, cyanosis), signs of heart failure, shock
- RESP: tenderness, sternal fractures, clavicle integrity, tracheal position, haemo/pneumothorax
INVESTIGATIONS
- CXR
- ECHO: RWMA, contractility, valvulopathy, tamponade
- CT chest: aortogram
- TNT
- ECG: ST changes, TW changes, blocks, RBBB
MANAGEMENT
- -> surgery (if indicated)
- -> angiography (if indicated)
- -> supportive
- -> monitoring for arrhythmias
- -> replace electrolytes
- -> inotropes
- -> IABP
References and Links
- Parr MJ. Blunt cardiac injury. Minerva Anestesiol. 2004 Apr;70(4):201-5. Review. PubMed PMID: 15173696. [Free Full Text]
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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