What are the clinical manifestations of blunt cardiac injury (BCI)?

From the Guidelines

Blunt cardiac injury (BCI) can manifest clinically as myocardial concussion, myocardial contusion, cardiac chamber rupture, septal rupture, pericardial rupture, valvular injuries, and posttraumatic coronary dissection.

Clinical Manifestations

• Myocardial concussion (commotio cordis) can lead to fatal ventricular arrhythmias 1
• Myocardial contusion may present with electrocardiographic (ECG) abnormalities, chest pain, and hemodynamic instability 1
• Cardiac chamber rupture is usually associated with a high mortality rate and may cause hemodynamic instability due to pericardial effusion and tamponade 1
• Septal rupture and valvular injuries can also lead to hemodynamic instability and require prompt diagnosis and treatment 1
• Posttraumatic coronary dissection may mimic myocardial contusion and can cause myocardial infarction 1

Diagnosis

• Bedside transthoracic echocardiography (TTE) is the first-line imaging modality for evaluating blunt cardiac trauma in patients with abnormal ECG and elevated cardiac troponins 1
• TTE can help diagnose wall motion abnormalities, pericardial effusion, and valvular injuries 1
• Transesophageal echocardiography (TOE) may be superior to TTE for investigating the cause of persistent hemodynamic instability or other problems potentially related to cardiac injury 1

From the Research

Clinical Manifestations of Blunt Cardiac Injury (BCI)

The clinical manifestations of BCI can vary widely, ranging from minor to life-threatening injuries. Some common manifestations include:

• Abnormal electrocardiogram (ECG) readings 2, 3, 4, 5, 6
• Hemodynamic instability, including shock or hypotension 2, 3, 4, 5, 6
• Cardiac arrhythmias, including ventricular arrhythmias 2, 5, 6
• Cardiac pump failure 3
• Myocardial contusion, which can lead to arrhythmias or cardiac failure 2, 5
• Valvular disruption or acute valvular disorders 5, 6
• Cardiac rupture, which can be fatal if not promptly treated 2, 6
• Coronary artery thrombosis 6

Diagnosis and Management

Diagnosing BCI can be challenging due to the nonspecific nature of the signs and symptoms. However, the following diagnostic tools can be useful:

• Electrocardiogram (ECG) to detect abnormal heart rhythms or signs of cardiac injury 2, 3, 4, 5, 6
• Echocardiography to evaluate the heart and detect any structural damage or valvular disorders 2, 4, 5, 6
• Computed tomography (CT) scans to rapidly identify injuries in hemodynamically unstable patients 2
• Cardiac enzymes, such as creatine phosphokinase isoenzyme levels, to detect cardiac damage 5, 6

Prognosis and Outcome

The outcome of BCI can be favorable if patients receive prompt medical attention and other injuries do not supervene. With proper surgical and anesthetic care, survival rates can reach 66%-75% in cases involving urgent cardiac repair 2. However, the prognosis is generally poor for patients with severe BCI, especially those with cardiac rupture or other life-threatening injuries 6.