Myocardial contusion

Definition

Myocardial contusion is a bruise of the heart muscle.

Alternative Names

Blunt myocardial injury

Causes, incidence, and risk factors

The most common causes are:

• Car accidents
• Person getting hit by a car
• Cardiopulmonary resuscitation (CPR)
• Falling from a height greater than 20 feet

Symptoms

A severe myocardial contusion may lead to signs and symptoms of a heart attack.

Symptoms can include:

• Pain in the front of the ribs or breastbone
• Feeling that your heart is racing
• Light-headedness
• Nausea or vomiting
• Shortness of breath
• Weakness

Signs and tests

The doctor or nurse will perform a physical exam. This may show:

• Bruise or scrapes on the chest wall
• Crunching sensation when touching the skin, if there are rib fractures and puncture of the lung
• Fast heartbeat
• Irregular heartbeat
• Low blood pressure
• Rapid or shallow breathing
• Tenderness to the touch
• Abnormal chest wall movement from rib fractures

Tests may include:

• Blood tests (cardiac enzymes, such as Troponin-1 or CKMB)
• Chest x-ray
• CT scan of the chest
• Electrocardiogram (ECG or EKG)
• Echocardiogram

These tests may show:

• Problems with the heart wall and the ability for the heart to contract
• Fluid or blood in the thin sac surrounding the heart (pericardium)
• Rib fractures, lung or blood vessel injury
• Problem with the heart's electrical signaling (such as a bundle branch block or other heart block)
• Fast heart beat starting at the sinus node of the heart (sinus tachycardia)
• Abnormal heartbeast starting in the ventricls or lower chambers of the heart (ventricular dysrhythmia)

Treatment

You will be closely monitored for 24 hours. An electrocardiogram (ECG) will be done continually to check your heart function.

Emergency room treatment may include:

• Catheter placement through a vein (IV)
• Medications to relieve pain, heart rate disturbances, or low blood pressure
• Pacemaker (temporary, may be permanent later)
• Oxygen

Other therapies may be used to treat a heart injury, include:

• Chest tube placement
• Draining blood from around the heart
• Surgery to repair  blood vessels in the chest

Support Groups

Expectations (prognosis)

A complete recovery is usually seen in those with a mild myocardial contusion. 

Serious heart injuries can increase your risk for heart failure or heart rhythm disturbances.

Complications

Calling your health care provider

Prevention

The following safety tips may help prevent a heart bruise:

• Wear a seat belt when driving
• Choose a car with air bags
• Take appropriate safety precautions when working at heights

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References

Hamilton RS. Myocardial contusion. In: Rosen P, Barkin RM, Hayden Sr, Schaider JJ, Wolfe R, eds. Rosen and Barkin's 5-Minute Emergency Medicine Consult. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2007.

Eckstein M, Henderson SO. Thoracic Trauma. In: Marx, JA, ed. Rosen’s Emergency Medicine. 7th ed. Saint Louis, Mo: Mosby Elsevier: 2009: chap 42.