Blunt Trauma to the Heart: A Review of Pathophysiology and Current Management

Blunt cardiac injury in the hemodynamically stable patient

“…Other common mechanisms include bidirectional compression of the heart between the sternum and spine; abrupt pressure fluctuations in the chest or abdomen; shearing injuries seen in rapid decelerations causing tears to valves, coronary arteries, or myocardium; or a combination of these structural problems. 3,4 Significant BCI usually occurs in high-speed motor vehicle collisions, pedestrians struck by motor vehicles, motorcycle collisions, and falls from greater than 20 ft (6.1 m). 3 BCI includes a range of injuries, and may only be clinically evident based on presenting symptoms, signs, or test results from which injury to the heart is inferred.…”

“…In commotio cordis, cardiac impact during a period of electrical vulnerability, such as ventricular repolarization, leads to ventricular fibrillation and sudden cardiac arrest. 4,6 Structural injuries associated with BCI are less common but are associated with greater morbidity and mortality and include heart chamber rupture (almost always with associated hemopericardium), acute valvular incompetence, septal perforation, pericardial injury, and coronary artery dissection or occlusion. 4,6 Between 10% and 32% of blunt traumatic fatalities are associated with cardiac injury, with 65% of these cardiac injuries being from cardiac rupture.…”

“…4,6 Structural injuries associated with BCI are less common but are associated with greater morbidity and mortality and include heart chamber rupture (almost always with associated hemopericardium), acute valvular incompetence, septal perforation, pericardial injury, and coronary artery dissection or occlusion. 4,6 Between 10% and 32% of blunt traumatic fatalities are associated with cardiac injury, with 65% of these cardiac injuries being from cardiac rupture. 1 The incidence of injuries to valves and coronary arteries is low, but when they occur, the mitral and aortic valves most often are affected and the left anterior descending coronary artery is the most commonly injured artery.…”

“…1 The incidence of injuries to valves and coronary arteries is low, but when they occur, the mitral and aortic valves most often are affected and the left anterior descending coronary artery is the most commonly injured artery. 4 Chamber rupture occurs first in the ventricles before the atria, most often during the high-pressure phase in diastole, and in the right side of the heart before the left, secondary to anterior anatomical location under the sternum. 4 Finally, markedly depressed ventricular function in the absence of…”

“…4 Chamber rupture occurs first in the ventricles before the atria, most often during the high-pressure phase in diastole, and in the right side of the heart before the left, secondary to anterior anatomical location under the sternum. 4 Finally, markedly depressed ventricular function in the absence of…”