Diagnosing cardiac contusion : old wisdom and new insights K C Sybrandy, M J M Cramer and C Burgersdijk 20 November 2002 CS Intern 이웅재

car or motorcycle accidents incidence ; 3-56 %

Possible complications of cardiac injury ventricular arrhythmias and cardiac failure (16%) ; It is important to screen all patients with blunt chest trauma to identify risk for complications.

CAUSES AND CLINICAL FEATURES steering wheel or rapid deceleration ; thoracic wall compresses the heart between the sternum and spine falls from a great height, sport injuries, blast forces, and indirect compression on the abdomen with upward displacement of abdominal viscera

Hemodynamic instability ; easily masked in trauma patients due to other severe injuries with blood loss or associated pulmonary, vascular, and neurological injuries. only mild symptoms, such as palpitations or precordial pain

Chest radiography and thoracic computed tomography Magnetic resonance imaging

BIOCHEMICAL CARDIAC MARKERS First screening tool Histologicaly ; intramyocardial hemorrhage, edema, and necrosis of myocardial muscle cells Creatine kinase (CK) CK-MB troponin I and troponin T (myocardial regulatory contractile proteins) ; measurment after 4-6 hours / persist for 4-6 days

Electrocardiographic findings The ECG after blunt chest trauma ; normal or non-specific abnormalities right ventricle > left ventricle

ECHOCARDIOGRAPHY functionally

RADIONUCLIDE IMAGING Ventriculography Myocardial perfusion scintigraphy Positron emission tomography

IDENTIFICATION OF PATIENTS AT RISK troponin I and troponin T ; very helpful in the stratification of patients at risk for complications.

Screening strategy

TREATMENT Cardiac monitoring ; Complication - within 24-48 hours after the trauma.

CONCLUSION Diagnosing a cardiac contusion remains a significant challenge. cardiospecific troponin I and troponin T assays ; much easier to detect myocardial injury / risk for life threatening complications. combination with an ECG ; sufficient for identifying the vast majority of patients who were at risk

Moreover, patients with normal troponin I or T concentrations and ECG can be safely sent home.