ECG Changes in Heart Contusion
Heart contusion can present with various ECG changes including ST-segment elevation or depression, T-wave inversions, conduction abnormalities, and arrhythmias, similar to those seen in myocardial ischemia or infarction. 1
Common ECG Findings in Heart Contusion
- ST-segment changes are frequently observed, including both elevation and depression, similar to those seen in acute myocardial ischemia 2, 1
- T-wave inversions may be present in multiple leads, reflecting myocardial injury 2, 1
- Arrhythmias can occur, ranging from sinus tachycardia to more complex ventricular arrhythmias 3
- Conduction abnormalities including intraventricular and atrioventricular conduction delays may be seen 2
- Loss of precordial R wave amplitude can indicate significant myocardial damage 2
- QTc prolongation may be present, similar to other forms of myocardial injury 4
Diagnostic Approach
- Serial ECGs are essential as changes may evolve over time, similar to acute coronary syndromes 2, 1
- Initial ECGs may show only subtle changes that progress over hours to more obvious abnormalities 5
- Comparison with previous ECGs (when available) is crucial to identify new changes 2
- ECG changes should be interpreted in the clinical context of blunt chest trauma 1
Specific ECG Patterns to Look For
- ST-segment elevation in anatomically contiguous leads may indicate focal myocardial injury 2
- ST-segment depression ≥0.05 mV in two contiguous leads may suggest subendocardial injury 2
- T-wave inversion >0.1 mV in two contiguous leads can be a sign of myocardial contusion 2
- Terminal QRS distortion and hyperacute T-waves may be early signs of significant myocardial injury 5
Clinical Correlation
- The presence of ischemic-appearing ECG changes significantly increases the likelihood of true myocardial injury 6
- Normal ECGs and biomarker tests in suspected myocardial contusion patients may allow for safe discharge, while abnormal results warrant further investigation with echocardiography 1
- Life-threatening cardiac complications occur in approximately 29% of patients with cardiac contusions 3
- The development of cardiac complications following contusion has a significant relationship to the presence of shock and hypoxia 3
Important Considerations
- ECG changes alone are insufficient to diagnose heart contusion and should be correlated with cardiac biomarkers and imaging 1
- ECG abnormalities in heart contusion can mimic those seen in acute coronary syndromes, making differentiation challenging 2, 1
- The severity of ECG changes does not always correlate with the clinical severity of the contusion 3
- Patients with significant ECG changes should be monitored closely for the development of arrhythmias or heart failure 1, 3
Remember that diagnosing myocardial contusion is challenging due to its nonspecific symptoms, and cardiogenic shock or arrhythmias must be anticipated in affected patients 1.