Blunt Cardiac Trauma - Symptoms, Diagnosis, and Treatment

Introduction

Blunt cardiac trauma ranges from myocardial lesions and arrhythmias (irregular heartbeats) to deadly heart rupture. When the heart is hurt following blunt chest trauma, it is also known as a cardiac contusion. A blunt trauma to the myocardial muscles causes excessive bleeding, regional necrosis (the death of cells), and edema (excessive fluid trapped in the body), which are its histological hallmarks. However, these findings are found during surgery or an autopsy. Although abrupt chest trauma can cause a wide variety of cardiac injuries, blunt cardiac injury is the most common diagnosis.

How Does Cardiac Blunt Trauma Occur?

The substantial blunt cardiac trauma that results from high-impact trauma is due to:

• Auto accidents.

• Pedestrian auto collisions.

• Large height falls.

• Motorcycle accidents.

Automobile accidents account for 50 percent of all fatalities from motor vehicle accidents and are the most common source of blunt cardiac trauma. The method and amount of force play a role in the severity of the cardiac injury. With enough force, the heart can be forced between the sternum and the spine. Deceleration damage could rip the heart away from its connections. Because these injuries frequently result in death, patients typically pass away right away. Among the nearby structures that could be hurt by blunt cardiac damage are the sternum, lung, ribs, and spine.

What Is the Mechanism of Action of Cardiac Blunt Trauma?

• The most frequent mechanism is direct chest trauma, and cardiac damage is most likely when the ventricles are maximally enlarging at the end of diastole.

• The most frequent cardiac injuries from physical trauma that result in death are as follows:

  1. The rupture of the heart chamber.

  2. Tears in the venous-atrial connections.

  3. Coronary artery tear or dissection.

  4. Combination of these.

• An abrupt rise in intracardiac pressure caused by an indirect increase in preload through the veins of the abdomen or the extremities can put the heart at risk of rupture.

• Compression of the heart between the spine and sternum is caused by bidirectional forces.

• Deceleration processes may cause tears in the myocardial, coronary arteries, or valvular tissues.

• The location of the heart in the chest, with the right ventricle and right atrium, is more anterior than the left ventricle and left atrium, which also results in more frequent injuries on the right side of the heart.

What Are the Signs and Symptoms of Blunt Cardiac Trauma?

The signs and symptoms of blunt cardiac trauma are as follows:

• Chest pain.

• Shortness of breath.

• Palpitations.

• Ecchymosis (discoloration of the skin).

• Angina-like symptoms (heart attack-like symptoms).

• Tachypnea (increased breathing).

• Chest abrasion.

• Abnormal lung sounds.

• Chest wall pain.

• Rib or sternal fractures.

What Is Commotion Cordis?

Commotion cordis refers to sudden death from cardiac arrest brought on by blunt cardiac trauma when there is no evidence of a prior illness and no physical damage to the heart. This condition is typically found in young male athletes.

How Is Cardiac Blunt Trauma Diagnosed?

There is no recognized gold standard diagnostic test for blunt cardiac trauma. For the polytrauma patient, the diagnosis is even more challenging.

1. Sonography for Trauma (Fast Exam) - Sonography helps assess the pericardial fluid and cardiac tamponade.

2. The Eastern Association of Trauma (East) Guidelines -

• These guidelines were developed in 2012 for blunt cardiac trauma, which encourages taking an electrocardiogram (ECG) from every patient who had a blunt cardiac trauma suspicion.

• However, a normal ECG does not completely rule out blunt cardiac trauma because a significant number of patients have a possible cardiac injury 24 hours later as measured by elevated cardiac troponin I level.

• Patients with abnormal findings should be admitted for continuous cardiac monitoring.

• Nonetheless, individuals who have a normal ECG and normal cardiac troponin I levels can go home safely after being treated.

• Computerized tomography (CT) and magnetic resonance imaging (MRI) may be complementary or helpful in patients who have symptoms without a known clinical cause and should be taken into consideration on an individual basis.

What Is the Management of Blunt Cardiac Trauma?

• Individuals with abnormalities in their ECG and cardiac troponin I levels should be admitted for 24 to 48-hour cardiac surveillance because this is when life-threatening arrhythmias or cardiac failure are most likely to manifest.

• Depending on the severity of the hemodynamic imbalance, the type of ECG alteration, and the concurrent traumas, patients may be admitted to the critical care unit or placed under telemetry.

• The use of life support techniques is also advised.

• Complete heart block with isolated blunt cardiac trauma may need a pacemaker.

• Dysrhythmia (abnormal heartbeat) management should be carried out.

• A myocardial infarction caused by trauma or a contused heart can both cause ST segment elevations in the ECG indicating a need for coronary angiography.

• For further management, patients with significant clinically diagnosed or imaged structural heart injury need an urgent cardiology examination. Based on the individual clinical findings and related injuries, interim temporary interventions like fluid resuscitation, or vasopressors may be required.

• Restore electrolytes as necessary, and prevent hypoxia (lack of oxygen) and acidosis (excess acid buildup).

• Emergent surgical intervention is necessary for patients who present with cardiac tamponade (fluid accumulation in the pericardial sac causing compression of the heart), which is most typically observed in heart rupture.

What Is the Differential Diagnosis of Blunt Cardiac Trauma?

• Arrhythmia (irregular heartbeat).

• Cardiac wall motion abnormality.

• Cardiac tamponade (fluid accumulation in the pericardial sac causing compression of the heart).

• Valvular regurgitation (heart valve disease).

• Cardiogenic shock

• Hemorrhagic shock.

• Cardiogenic pulmonary edema.

• Myocardial infarction (heart attack).

Conclusion

It is critical to evaluate cardiac risk factors such as the history of myocardial infarction and cardiovascular illnesses that are frequently present. Medication evaluation is crucial, especially if the patient is on cardiac medications that may change how they present. For instance, tachycardia (increased heart rate) may be covered up by beta-blockers and calcium channel blockers. Having a keen suspicion for trauma patients is essential in providing care for these individuals, with the knowledge that blunt cardiac trauma can take up to 48 hours to appear. ECG can be utilized as a screening technique, followed by admission and echocardiography for any resulting abnormalities. Thus, a complete physical examination is required to establish blunt cardiac trauma and treat it further.