Traumatic cardiac injury in chest trauma

Introduction

Blunt chest trauma is often accompanied by traumatic cardiac injury (TCI), formerly called cardiac contusion. Severe TCI can affect the prognosis of chest trauma patients due to cardiac arrhythmias, heart failure, or cardiac tamponade. The objective of this study was the detection and evaluation of TCI in chest trauma.

Methods

Twenty-seven consecutive patients without cardiac disease history (five females), mean age 37.2 years (63% <35 years) were admitted to the ICU with blunt chest trauma. Five patients had minor head brain injury. The majority needed mechanical ventilation support. The mean Injury Severity Score (ISS) was 21.1 (11–34). The following injuries/lesions of thorax or lung parenchyma were identified on chest and abdominal CT scan: fractures of clavicle, sternum, ribs, scapula or vertebral column, lung contusion, hemo/pneumothorax, hemo/pneumomediastinum, abdominal organ injury. TCI diagnosis was based on auscultation findings (pericardial friction rub, new cardiac murmurs), electrocardiogram (ECG) findings (ST–T disturbances, arrhythmias), cardiac enzymes (CE) (cardiac Tropinin I, CK-MB), transthoracic echocardiography (TTE) (wall motion abnormalities (WMA), reduced left ventricular ejection fraction (LVEF) pericardial effusion (PE)), and thorax CT findings.

Results

Twenty-two out of 27 patients (81%) exhibited at least one sign of TCI, 17/27 (63%) had more than two signs: ECG changes (18/22, 81.8%), mostly ST–T disturbances of left precordial or inferior leads, slight CE increase (17/22, 72%), PE in TTE or CT (12/22, 54,5%), WMA, mostly of the interventricular septum wall (6/22, 27%), reduced LVEF (5/22, 23%), or pericardial friction rub (5/22, 23%). Patients with TCI signs had more frequently bilateral or right-sided hemothorax (16/22, 72%), bilateral lung contusion (15/22, 68%), right-sided rib fracture (15/22, 68%), abdominal organ injury (spleen, left kidney/adrenal, liver) (14/22, 63%) or right-sided pneumothorax (13/22, 59%). Two patients (one with flail chest) exhibited PE leading to cardiac tamponade. Pericardiocentesis was performed with success. None of the patients had severe ventricular arrhythmia. Five young patients had mildly reduced LVEF, in almost all cases transient. There was a positive correlation between ISS and TCI severity.

Conclusion

TCI is frequent in blunt chest trauma. Additional ECG findings and an increase in CE suggest possible TCI to be confirmed by a bedside TTE study. TCI usually accompanies bilateral hemothorax, lung contusion, or right-sided rib fracture.