Cardiac Contusions

Abstract

Cardiac contusion has been one of the most discussed topics in the trauma community. The discussions are centered around appropriate nomenclature, screening mechanisms, diagnostic modalities, and ultimately management principles. Controversy over nomenclature exists because cardiac contusion has been used to describe an array of injuries ranging from a transient arrhythmia to free rupture of the myocardial wall. The mainstays of screening have been electrocardiograms and cardiac isoenzymes. Although there is a substantial body of literature, few other screening or diagnostic modalities have been widely accepted. Echocardiography has gained favor as a confirmatory test and to determine presence or extinct of structural damage. Management has traditionally been supportive including volume repletion, correcting arrhythmias, and repairing structural damage. Recently, there has been some promising alternative treatments including transcatheter closure of ventricular septal defects, anti-inflammatory agents, and post-injury therapeutic hypothermia. Although screening and diagnostic mechanism have remained relatively unchanged, it appears that innovative management of severe cardiac contusions has gained some momentum over the recent years.