Blunt cardiac injury

Last revised by Daniel J Bell on 25 Mar 2019

Most commonly a result of sudden deceleration or direct precordial impact, blunt cardiac injury (BCI) encompasses a spectrum of structural and functional cardiac derangements which may occur after trauma to the heart 7.

While sometimes referred to with general terms such as "cardiac contusion," blunt cardiac injury represents a spectrum of injuries which may be stratified based on injury severity (the AAST organ injury scale is sometimes used) or anatomical structure affected. 

Blunt cardiac injury may account for an estimated 20% of fatalities occurring as a result of a motor vehicle collision 3.

Presenting symptoms may be non-specific, vary greatly, and appear attributable to coexisting injuries and/or pre-existing medical conditions including:

  • chest pain
  • dyspnea
  • palpitations
  • presyncope

Features on the electrocardiogram include 7:

  • sinus tachycardia
  • pathologic Q wave formation
  • elevation of the ST segment
  • new bundle branch blocks and/or atrioventricular (AV) nodal blocks
  • ventricular fibrillation
    • in the context of an injury not producing structural damage referred to as commotio cordis

A chest radiograph may demonstrate associated features, including:

Sonographic features of blunt cardiac injury are highly variable. Manifestations detectable by transthoracic echocardiography may appear as follows, based on the structure injured 4:

Transesophageal echocardiography is considered a superior modality, also highly sensitive for associated great vessel injuries, including 3:

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Cases and figures

  • Case 1: blunt cardiac injury
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