A blunt cardiac injury is einstumpfes chest trauma that causes a bruise to the heart muscle, breakage or interruption of a heart chamber of a heart valve. Sometimes a blow to the anterior chest wall causes a cardiac arrest without structural lesion (concussion cordis).
The symptoms vary with the injury.
A blunt cardiac injury is einstumpfes chest trauma that causes a bruise to the heart muscle, breakage or interruption of a heart chamber of a heart valve. Sometimes a blow to the anterior chest wall causes a cardiac arrest without structural lesion (concussion cordis). The symptoms vary with the injury. Myocardial contusion can be small and asymptomatic, despite the presence of a tachycardia. Some patients develop conduction disturbances and / or arrhythmia. A ventricular rupture is usually rapidly fatal, but patients with smaller, especially right-sided lesions with cardiac tamponade survive (pericardial tamponade). A tamponade due to atrial crack can manifest themselves gradually. A valve may malfunction, which sometimes manifestations of heart failure (eg. As shortness of breath, pulmonary rales, sometimes low blood pressure) leads to a heart murmur and that can develop rapidly. A Ventrikelseptumruptur may possibly initially cause no symptoms, but patients may have heart failure later. Concussion cordis is sudden cardiac arrest, following a blow to the anterior chest wall in patients who have no existing or traumatic structural heart disease. Typically, this includes a strike fast and hard projectile (z. B. baseball, hockey puck) with relatively low kinetic energy. The pathophysiology is unclear, but the timing of the strike with respect to the cardiac cycle can be important. The initial rhythm is usually ventricular fibrillation diagnostic ECG echocardiography cardiac enzymes A cardiac injury should be suspected in patients with significant breast or multiple blunt trauma, and any palpitations, cardiac arrhythmias, new heart murmur or unexplained tachycardia or hypotension. Most patients with significant blunt chest trauma should receive a 12-lead ECG. In cardiac contusion an ECG ST-segment changes, cardiac ischemia or infarction can mimic disclose. Among the most common conduction disorders include atrial fibrillation, bundle branch block (usually right), unexplained sinus tachycardia and single or multiple premature ventricular contractions. Echocardiography is sometimes performed during initial resuscitation and can show wall motion disorders, pericardial fluid and the chamber or Herzklappenruptur. Patients who are due to clinical or ECG findings suspected to have a contusion should receive formal echocardiography to assess functional and anatomical abnormalities. It is very helpful for cardiac markers (eg. As troponin, CPK-MB) to look and so help to exclude a blunt cardiac injury. If cardiac markers and ECG are normal and there is no arrhythmia, a blunt cardiac injury can be safely excluded. Therapy Supportive care patients caused by myocardial contusion that conduction disturbances, require cardiac monitoring for 24 hours, as they have with a risk for sudden cardiac arrhythmia during this time. The treatment is mainly supportive (z. B. Treatment of symptomatic cardiac arrhythmias or heart failure), and is rarely needed. Surgical repair is indicated for rare cases of heart valve defects or rupture. Patients with concussion cordis are treated on their arrhythmias (eg. As resuscitation with CPR and defibrillation followed by observation in the hospital). Key points A cardiac injury should be suspected in patients with significant breast or multiple blunt trauma, and any palpitations, cardiac arrhythmias, new heart murmur or unexplained tachycardia or hypotension. ECG and cardiac markers are useful to check for injuries and an echocardiogram is useful to evaluate functional and anatomical abnormalities. Patients with conduction disturbances or arrhythmia requiring cardiac monitoring.