Blunt cardiac injury

Blunt cardiac injury (BCI), formerly known as myocardial contusion, refers to a spectrum of injuries ranging from minor abnormalities on an electrocar diogram (ECG) to blunt cardiac rupture. Most clinical reviews (including th is one) focus on the diagnosis and management of patients with blunt injury short of rupture. Patients in motor vehicle crashes with deceleration/compression account for 80% to 90% of hospital admissions for BCI. The presence of arrhythmias or conduction delays on the first ECG in the emergency center or, much less co mmonly, persistent hypotension not explained by the loss of blood in the in jured patient is strongly suggestive of the diagnosis. The frequency of the se problems mandating admission to the hospital, however, is <1% in patient s with blunt thoracic trauma. There is no convincing evidence that measurement of creatine phosphokinase myocardial band (CPK-MB) enzyme levels, the measurement of cardiac troponin T and I contractile protein levels, or performing a radioisotope cardiac s can add to a diagnosis of BCI based on an abnormal admission EGG. Transesop hageal echocardiography is best reserved for patients with hypotension in a ssociation with an ECG diagnosis of BCI. Emergency operations in patients with BCI can be safely performed with appr opriate monitoring, treatment for arrhythmias as needed, and the addition o f inotropes when hypotension occurs.