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Myocardial contusion

Blunt myocardial injury

 

Myocardial contusion is a bruise of the heart muscle.

Causes

 

The most common causes are:

  • Car crashes
  • Getting hit by a car
  • Cardiopulmonary resuscitation (CPR)
  • Falling from a height, most often greater than 20 feet (6 meters)

 

Symptoms

 

A severe myocardial contusion may lead to signs and symptoms of a heart attack.

Symptoms can include:

  • Pain in the front of the ribs or breastbone
  • Feeling that your heart is racing
  • Lightheadedness
  • Nausea or vomiting
  • Shortness of breath
  • Weakness

 

Exams and Tests

 

The health care provider will perform a physical exam. This may show:

  • Bruise or scrapes on the chest wall
  • Crunching sensation when touching the skin if there are rib fractures and puncture of the lung
  • Fast heartbeat
  • Irregular heartbeat
  • Low blood pressure
  • Rapid or shallow breathing
  • Tenderness to the touch
  • Abnormal chest wall movement from rib fractures

Tests may include:

  • Blood tests (cardiac enzymes, such as Troponin-I or T or CKMB)
  • Chest x-ray
  • CT scan of the chest
  • Electrocardiogram (ECG or EKG)
  • Echocardiogram

These tests may show:

  • Problems with the heart wall and the ability for the heart to contract
  • Fluid or blood in the thin sac surrounding the heart (pericardium)
  • Rib fractures, lung or blood vessel injury
  • Problem with the heart's electrical signaling (such as a bundle branch block or other heart block)
  • Fast heartbeat starting at the sinus node of the heart (sinus tachycardia)
  • Abnormal heartbeat starting in the ventricles or lower chambers of the heart (ventricular dysrhythmia)

 

Treatment

 

In most cases, you will be closely monitored for at least 24 hours. An electrocardiogram (ECG) will be done continually to check your heart function.

Emergency room treatment may include:

  • Catheter placement through a vein (IV)
  • Medicines to relieve pain, heart rate disturbances, or low blood pressure
  • Pacemaker (temporary, may be permanent later)
  • Oxygen

Other therapies may be used to treat a heart injury, include:

  • Chest tube placement
  • Draining blood from around the heart
  • Surgery to repair blood vessels in the chest

 

Outlook (Prognosis)

 

People with a mild myocardial contusion will recover completely most of the time.

Serious heart injuries can increase your risk for heart failure or heart rhythm problems.

 

Prevention

 

The following safety tips may help prevent a heart bruise:

  • Wear a seat belt when driving.
  • Choose a car with air bags.
  • Take steps to ensure safety when working at heights.

 

 

References

Eckstein M, Henderson SO. Thoracic trauma. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 45.

Tsai PI, Wall MJ, Mattox KL. Traumatic heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 72.

 
  • Heart, section through the middle

    Heart, section through the middle - illustration

    The interior of the heart is composed of valves, chambers, and associated vessels.

    Heart, section through the middle

    illustration

  • Heart, front view

    Heart, front view - illustration

    The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

    Heart, front view

    illustration

    • Heart, section through the middle

      Heart, section through the middle - illustration

      The interior of the heart is composed of valves, chambers, and associated vessels.

      Heart, section through the middle

      illustration

    • Heart, front view

      Heart, front view - illustration

      The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.

      Heart, front view

      illustration

    A Closer Look

     

      Talking to your MD

       

        Self Care

         

          Tests for Myocardial contusion

           

             

            Review Date: 5/5/2016

            Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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