Home

Search

Pathway AI

Account ⋅ Sign Out

Table of contents

Blunt cardiac injury

Definition
BCI refers to an injury sustained due to blunt trauma to the heart, the spectrum of which ranges from a minor bruise to specific post-contusion cardiac conditions such as free-wall rupture.
1
Pathophysiology
BCI is mostly caused by motor vehicle accidents, falls from heights, direct blow to the chest wall by airbag deployment, crushing incidents, contact sports injuries, acts of violence, or blast trauma.
1
Disease course
Clinical manifestations include arrhythmias, myocardial contusion, wall motion abnormalities, myocardial wall rupture, and valve damage. The spectrum of injuries includes commotio cordis, cardiac rupture, coronary artery dissection, indirect cardiac injury, cardiac herniation, pericardial effusion and tamponade, traumatic cardiac arrest, and blunt aortic injury.
1
Prognosis and risk of recurrence
BCI is associated with an overall mortality rate of 13.9%.
2
Key sources
The following summarized guidelines for the evaluation and management of blunt cardiac injury are prepared by our editorial team based on guidelines from the Eastern Association for the Surgery of Trauma (EAST/WTA/PTS 2023), the American College of Radiology (ACR 2020), and the Eastern Association for the Surgery of Trauma (EAST 2015; 2012).
1
2
3
4
5
6

Guidelines

1.Screening and diagnosis

Patients at risk: admit patient for continuous ECG monitoring if the admission ECG reveals a new abnormality such as arrhythmias, ST changes, ischemia or heart block.
B
Create free account

More topics in this section

  • Indications for testing

2.Diagnostic investigations

Electrocardiogram: obtain an admission ECG in all patients in whom BCI is suspected.
A

More topics in this section

  • Continuous ECG monitoring

  • Troponin I

  • CK

  • Cardiac imaging

  • Chest imaging

  • Nuclear medicine studies

3.Surgical interventions

Resuscitative thoracotomy, adult patients
Consider performing emergency department thoracotomy in patients presenting pulseless to the emergency department after blunt injury with signs of life.
C
Avoid performing emergency department thoracotomy in patients presenting pulseless to the emergency department after blunt injury without signs of life.
D

More topics in this section

  • Resuscitative thoracotomy (pediatric patients)

4.Specific circumstances

Patients in need of surgical intervention: consider proceeding with surgery in elderly patients with known cardiac disease, unstable patients, and those with an abnormal admission ECG, provided that they are appropriately monitored. Consider placement of a pulmonary artery catheter in these situations.
C