Blunt myocardial injury

Alternative names
Myocardial contusion

Definition

Myocardial contusion is a “bruise” of the heart muscle, often caused by blunt trauma to the chest following falls, motor vehicle accidents, or cardio-pulmonary resuscitation (CPR). This can cause abnormal heart movement and “stunning” of the affected area of heart muscle.
In non-severe cases, the affected area of heart muscle often regains its function without any permanent scarring.

Causes, incidence, and risk factors
The most common causes are falls from heights greater than 20 feet, motor vehicle accidents (usually the driver due to contact with the steering wheel), or during Cardiopulmonary resuscitation (CPR).

Symptoms
Pain in the breastbone (sternum) alerts the physician that an injury may have been sustained. Usually there are no symptoms other than a feeling that one’s heart is racing.

Signs and tests

The signs, which are noted on electrocardiogram (ECG), are (in order of frequency) sinus Tachycardia, right bundle branch block, ventricular dysrhythmia.

Additionally, an Echocardiogram may reveal abnormalites in the ability of the ventricle to contract (wall motion abnormalities)

Treatment
Treatment is usually supportive. Patients are watched for 24 hours with continuous ECG monitoring. Some may require pain medication for sternal pain.

Expectations (prognosis)
The expectation is that a full recovery will occur.

Complications
The main complication is that the bruising may lead to myocardial infarction (heart muscle death). This may lead to prolonged weakness in the ability of the heart to contract.

Prevention
Keys to preventing myocardial contusion are basic safety precautions, including wearing a seat belt when driving and purchasing an automobile with air bags.

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