Is There a Gold Standard for Screening Blunt Cardiac Injury?

Blunt cardiac injury in the hemodynamically stable patient

“…BCI represents a range of injuries after blunt chest trauma. An estimated 0.3% of all patients admitted for trauma are diagnosed with some type of BCI, and patients can present with a wide range of signs and symptoms 1,2. The mechanism most commonly associated with BCI is a direct impact to the chest wall, such as steering wheel trauma during a motor vehicle crash.…”

“…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…”

“…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 structural injury may be encountered and usually is diagnosed in patients with refractory hypotension and echocardiographic findings of an akinetic ventricle 1. These injuries likely represent true contusions of a significant mass of myocardium and, though severe, may resolve without therapy.…”

“…These injuries likely represent true contusions of a significant mass of myocardium and, though severe, may resolve without therapy. Intra-aortic balloon pumps may be useful in patients with severely depressed left ventricular function 1…”

“…No gold standard exists for diagnosis of BCI, although in hemodynamically unstable patients, diagnosis can be made by direct visualization of the heart 1. This can be accomplished with pericardial window, thoracotomy, or sternotomy.…”