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Introduction: Albeit described since 1763, cardiac contusions is still an under-recognised clinical condition in the acute care setting. This evidence-based review aims to provide an overview of the topic by focusing on etiopathogenesis, classification and clinical presentation of patients with cardiac contusions, as well as on the diagnostic work-up and therapy options available for this subset population in the acute care setting., Methods: A targeted research strategy was performed using PubMed, MEDLINE, Embase and Cochrane Central databases up to June 2022. The literature search was conducted using the following keywords (in Title and/or Abstract): ("cardiac" OR "heart" OR "myocardial") AND ("contusion"). All available high-quality resources written in English and containing information on epidemiology, etiopathogenesis, clinical findings, diagnosis and management of cardiac contusions were included in our research., Results: Biochemical samples of cardiac troponins together with a 12‑lead ECG appear to be sufficient screening tools in hemodynamically stable subjects, while cardiac ultrasound provides a further diagnostic clue for patients with hemodynamic instability or those more likely to have a significant cardiac contusion., Conclusions: The management of patients with suspected cardiac contusion remains a challenge in clinical practice. For this kind of patients a comprehensive diagnostic approach and a prompt emergency response are required, taking into consideration the degree of severity and clinical impairment of associated traumatic injuries., Competing Interests: Declaration of Competing Interest the authors declare they have no conflicts of interest, financial or otherwise to disclose., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Cardiac contusion is usually caused by blunt chest trauma and, although it is potentially a life-threatening condition, the diagnosis of a myocardial contusion is difficult because of non-specific symptoms and the lack of an ideal test to detect myocardial damage. Cardiac enzymes, such as creatine kinase (CK), creatine kinase MB fraction (CK-MB), cardiac troponin I (cTn-I), and cardiac troponin T (cTn-T) were used in previous studies to demonstrate the blunt cardiac contusion (BCC). Each of these diagnostic tests alone is not effective for diagnosis of BCC. The aim of this study was to investigate the serum heart-type fatty acid binding protein (h-FABP), N-terminal pro-B-type natriuretic peptide (NT-proBNP), CK, CK-MB, and cTn-I levels as a marker of BCC in blunt chest trauma in rats. The eighteen Wistar albino rats were randomly allocated to two groups; group I (control) (n=8) and group II (blunt chest trauma) (n=10). Isolated BCC was induced by the method described by Raghavendran et al. (2005). All rats were observed in their cages and blood samples were collected after five hours of trauma for the analysis of serum h-FABP, NT-pro BNP, CK, CK-MB, and cTn-I levels. The mean serum NT-pro BNP was significantly different between group I and II (10.3 ± 2.10 ng/L versus 15.4 ± 3.68 ng/L, respectively; P=0.0001). NT-pro BNP level >13 ng/ml had a sensitivity of 87.5%, a specificity of 70%, a positive predictive value of 70%, and a negative predictive value of 87.5% for predicting blunt chest trauma (area under curve was 0.794 and P=0.037). There was no significant difference between two groups in serum h-FABP, CK, CK-MB and c Tn-I levels. A relation between NT-Pro BNP and BCC was shown in this study. Serum NT-proBNP levels significantly increased with BCC after 5 hours of the blunt chest trauma. The use of NT-proBNP as an adjunct to other diagnostic tests, such as troponins, electrocardiography (ECG), chest x-ray and echocardiogram may be beneficial for diagnosis of BCC.

Objective: To describe the use of initial electrocardiogram (ECG), follow-up ECG or equivalent monitoring, and troponin I in patients presenting with sternal fracture who are assessed in emergency departments or by front-line physicians., Design: Multicentre descriptive retrospective study., Setting: Two traumatology teaching centres in Quebec city, Que., Participants: Fifty-four trauma patients presenting with sternal fracture., Interventions: Assessment of the use of initial ECG, ECG or equivalent monitoring 6 hours after trauma, and troponin administration., Main Outcome Measures: In terms of ECG use, quality comparison criteria were selected on the basis of expert opinions in 4 studies. An initial ECG and a follow-up ECG 6 hours after trauma or cardiac monitoring 6 hours after trauma were recommended by most authors for diagnosing myocardial contusion in cases of sternal fracture. Serum troponin I administered 4 to 8 hours after chest trauma was also recommended by some as an effective means of detecting substantial arrhythmia secondary to myocardial contusion. Descriptive univariate analyses and tests were performed. A P < .05 was considered significant., Results: Thirty-nine patients (72%) were assessed initially with ECGs; after 6 hours in the emergency department, 18 of these patients (33%) had follow-up ECGs or equivalent cardiac monitoring. Sixteen patients (30%) were assessed by means of troponin I dosage. Two patients (4%) presented with ECG abnormalities and only 1 patient (2%) presented with an elevated troponin I level., Conclusion: Emergency physicians must increase their use of ECG in initial or follow-up diagnosis for trauma patients presenting with sternal fracture to detect myocardial contusion and arrhythmia. The use of troponin in conjunction with ECG is also suggested for this population in order to identify patients at risk of complications secondary to myocardial contusion.

Cardiac contusion may be frequently found in patients with blunt chest trauma, and it presents clinically as a spectrum of injuries of varying severity, including transient disorders of impulse formation and propagation. A rare observation of transient trifascicular block in a previously fit 32-year-old man involved in a car accident is reported. The importance of ECG monitoring and biochemical assessment of markers to unmask myocardial contusion is discussed.

Myocardial injury caused by blunt chest trauma has been recognized with increased frequency over the past 2 decades. Increased awareness by physicians and the increased use of various clinical and laboratory diagnostic modalities have contributed to this recognition. Injuries range from inconsequential to catastrophic and can affect any or all areas of the heart: pericardium, myocardium, coronary arteries and veins, chordae, papillary muscles, valves, and great vessels. In addition to the medical importance of the diagnosis, substantial forensic implications have been known to arise. It is important to assess and classify properly the extent of the trauma and its prognostication as to the possibility of residual sequelae. A proposed classification is presented that has both medical and legal application. The uses of stages 0 (suspect), I (mild), II (moderate), III (severe), and IV (catastrophic) are illustrated in detail.

A 65-year-old man had a pneumohaemothorax and fractured ribs after an automobile accident. Troponine concentrations were normal and the initial electrocardiographic abnormalities resolved within 24 hours. A 46-year-old man who was also in an automobile accident developed a seat-belt haematoma and lung oedema. Troponine concentrations were increased, the electrocardiogram was abnormal and transthoracic ultrasound revealed severe myocardial contusion. After a few weeks of treatment, both patients were discharged without cardiac complications. It is clinically important to identify patients at risk of developing myocardial contusion following blunt thoracic trauma. A combination oftroponine and electrocardiography is necessary to differentiate between risk categories. Echocardiography has a role in haemodynamically unstable patients and whenever the clinical condition of the patient deteriorates. A structured approach to screening and evaluation, as presented in an algorithm, can be used as a guide in the follow-up of patients with myocardial contusion.

Cardiac contusion following blunt chest trauma is not rare, and the works in the literature report incidence rates between 5 and 50%. Traffic accidents are the most frequent cause of cardiac contusion followed by violent fall impacts, aggressions and the practice of risky sports. The spectrum of post-traumatic cardiac lesions varies greatly, ranging from no symptoms to decrease in cardiac function. Cardiogenic shock is a rarely encountered manifestation of blunt cardiac contusion. We review our experience of cardiac contusion after blunt chest trauma, and we describe two very severe cases that manifested as cardiogenic shock. We emphasize an early diagnosis by continuous electrocardiographic monitoring, serial electrocardiograms, echocardiography, serum determination of biochemical cardiac markers, radionuclide imaging and coronary angiography. The treatment includes continuous monitoring of cardiac rhythm, use of inotropic drugs, insertion of a catheter in the pulmonary artery for continuous assessment of cardiac output and, in extreme cases, the insertion of a contrapulsation balloon to maintain haemodynamics until improvement of cardiac function.

The forensic diagnosis of cardiac contusion has hitherto been based mainly on anamnesis, concomitant thoracic injuries and the detection of macroscopic changes to the heart. Parallel histological and serological investigations of the heart-specific troponins have been conducted with varying results. This paper aims to show whether heart-specific troponins are suitable as a means of securing the diagnosis in proven cases of cardiac contusion and of determining which of the three heart-specific troponins cTnT, cTnI and cTnC are most significant in serology and histology for postmortem diagnosis. In the study, 25 cases of known cardiac contusion and 11 controls without vital myocardial trauma taken from autopsy material were prospectively investigated. Investigation of the venous serum revealed significant differences in the concentrations of the case and control groups for troponin T (mean value 5.5056 versus 0.4982; p=0.014), for troponin C (mean value 263.9280 versus 68.5640; p=0.001) and for troponin I (mean value 1404.0560 versus 36.1650; p=0.003). In histology there are also significantly different depletions between the groups investigated (cTnT: p=0.002; cTnC: p=0.003; cTnI: p<0.001) taking into account the autolysis time.

Blunt cardiac trauma most commonly manifests as a myocardial contusion. These contusions can cause cardiac enzyme leaks, electrocardiographic abnormalities, and cardiac contractile dysfunction making it difficult to differentiate a myocardial contusion from a peri-traumatic myocardial infarction. We present a case in which delayed contrast-enhanced cardiac magnetic resonance imaging was used to differentiate between contusion and myocardial infarction, leading to conservative management with subsequent complete restitution of myocardial function.

Objectives: Sudden cardiac deaths in previously healthy children are frequently due to undiagnosed cardiovascular diseases, either congenital or acquired. In an uncommon clinical entity known as commotio cordis, sudden death from cardiac arrest can occur in young athletes after a blunt blow to the chest, in the absence of preexisting cardiovascular disease. We present a case in which the clinician's high index of suspicion leads to the diagnosis of acute myocarditis in a patient whose sudden cardiac deterioration was initially attributed to the result of recent blunt chest trauma., Methods: A case report and review of literature via MEDLINE (1996-2004) search using the key words "myocarditis," "commotio cordis," and "myocardial contusion.", Results: A 12-year-old boy was admitted with elevated cardiac enzymes and respiratory distress after being hit in the chest with a dodgeball. Shortly after admission, the patient developed refractory ventricular arrhythmia, which was thought to be the result of blunt chest trauma. Further evaluation with endomyocardial biopsy, however, demonstrated acute myocarditis as the true etiology, for which the patient received immunosuppressive treatment. Unfortunately, the patient eventually required cardiac transplantation because of progressive irreversible cardiac dysfunction due to myocarditis., Conclusions: Although acute myocarditis, commotio cordis, and myocardial contusion can all present with malignant ventricular arrhythmia, other clinical features and approaches to management of each disease are very different. This case illustrates the importance of having a broad differential diagnosis in mind when presented with a previously healthy child in sudden cardiogenic shock.

Multidetector computed tomography (MDCT) cardiac findings in an unconscious teenager after blunt chest trauma are presented. Multidetector computed tomography enabled accurate comprehensive evaluation of the coronary arteries, myocardial perfusion, and left ventricular function. This case illustrates the full capabilities of MDCT in the evaluation of cardiac contusion in a noncooperative pediatric patient.

Background: To evaluate prospectively the effectiveness of monitoring end-diastolic volume (EDV) vs pulmonary artery occlusion pressure (PAO) as an estimate of cardiac preload in hemodynamically unstable critically ill 23 myocardial contusion patients with blunt chest trauma admitted to a university trauma center.., Methods: Patients were resuscitated (ATLS guidelines) with intubation and volume replacement for altered consciousness, hypoxemia or hemodynamic instability. Volume resuscitation and pulmonary artery catheterization were started to measure PAO, EDV, and oxygen utilization parameters. Myocardial performance was determined in both static (0., 24., 48., 72. hours) and dynamic condition after 500cc fluid bolus., Results: A moderate injury severity (GCS 9, TS 11, ISS 34) with MVA mechanism (91%), an average ICU stay of 14 days and a 39% mortality were revealed. Correlation of PAO, EDV with CO, CI demonstrated that EDV is more reliable than PAO However, factoring heart rate into CO determination was more reliable than single preload estimates of EDV-PAO-HR, HR-EDV, and HR-PAO. EDV-PAO-HR were correlated more strongly with cardiac output from 24 to 96 hours. A higher AV02 decrease was associated with improved survival, and a nearly significant decrease in EDV. Dynamic comparison found no change in cardiac performance with a small volume challenge., Conclusion: Simultaneous consideration of PAO, EDV, HR allowed the most accurate determination of cardiac output.

The diagnosis of myocardial contusion in the setting of blunt trauma engenders much discussion and controversy-partly because of the lack of a gold standard for its identification other than histologic findings at autopsy. Furthermore, blunt cardiac trauma represents a spectrum of disorders ranging from transient electrocardiographic change to sudden death from myocardial rupture; hence, no single terminology exists to define such a wide range of scenarios. Here, we present 2 cases of electrocardiographic ST-segment elevation after high-speed motor vehicle crashes resulting in numerous injuries, including blunt chest trauma. Both patients demonstrated electrocardiographic ST-segment elevation, resulting from myocardial contusion and acute myocardial infarction.

Myocardial contusion injury (MCI) is a complication of blunt thoracic trauma, which may occur at relatively low velocities. MCI may also occur from chest compressions during cardiopulmonary resuscitation. We review the clinical pathology, diagnostic tools, and treatment for MCI.

This case report is about a 62 year old woman who was involved in an accident while driving her car, during which the driver side air bag deployed. She experienced intense anterior chest pain that radiated to her left arm after the accident, but was otherwise well; there was no significant medical history. An electrocardiogram done one and half hours after admission revealed 1 mm ST segment elevation in leads V2 and V3 and troponin 1 level was raised. She underwent cardiac catheterisation but three months after the accident both ECG and echocardiographic studies were normal. It is suggested that she underwent cardiac contusion rather than a myocardial infarction.

A short cut review was carried out to establish the utility of troponin levels in diagnosing myocardial contusion following blunt chest trauma. Using the reported search, 75 papers were found, of which six presented the best evidence to answer the clinical question. The author, date, and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

The objective of this case report was to document a rare case of isolated myocardial contusion in the setting of blunt thoracic trauma. Although demonstrated by electrocardiogram and myocardium-specific enzymes, the trauma had no clinical relevance and the patient was discharged uneventfully from the intensive care unit. The clinical significance of blunt myocardial contusion is then discussed.

Cardiac contusion is usually caused by blunt chest trauma and therefore is frequently suspected in patients involved in car or motorcycle accidents. The diagnosis of a myocardial contusion is difficult because of non-specific symptoms and the lack of an ideal test to detect myocardial damage. Cardiac contusion can cause life threatening arrhythmias and cardiac failure. Many diagnostic methods, such as ECG, biochemical cardiac markers, transthoracic and transoesophageal echocardiography, and radionuclide imaging studies, have been investigated to determine their use in predicting such complications. Recently, cardiac troponin I and T were found to be highly sensitive for myocardial injury. Troponin I and T have also proved to be useful in the stratification of patients at risk for complications. Nevertheless, diagnosis of a cardiac contusion and identification of patients at risk remain a challenge. In this review the current diagnostic tests will be discussed. Also, based on these diagnostic tests, a screening strategy containing data from the latest studies is presented, with the intention of detecting patients at risk.

For many years the definition of blunt cardiac trauma has been unclear and several diagnostic methods have been employed. Recently, the importance of detecting only those patients who have a clinically significant cardiac trauma has been pointed out. Electrocardiography has shown itself to be the most important means in order to exclude the presence of a clinically significant cardiac trauma in a hemodynamically stable patient, determining troponin levels may be helpful at least in some patients.

Background: Patients with a blunt chest trauma often sustain myocardial contusion. The spectrum of symptoms varies from regional myocardial dysfunction to myocardial rupture or sudden cardiac death., Case Report: After a kick against his chest, a 27-year-old patient was resuscitated because of ventricular fibrillation. ECG and enzymatic pattern corresponded to an acute myocardial infarction, the echocardiogram revealed an apical and anteroseptal hypokinesia. 10 days after the acute event, coronary arteriography and ventriculography did not show any abnormalities., Conclusion: On the basis of the anamnesis, a myocardial contusion must be discussed as reason for the ventricular fibrillation and the pathologic findings in ECG and echocardiogram. This has to be considered in the therapy.

Purpose of the Study: Heart contusion is a severe injury for the diagnosis of which there still doesn't exist a uniform procedure. The aim of the work was to compare individual methods and provide opinion on the justification of their use., Material: In the period of 1998-2000 at the authors' departments 103 patient were hospitalised with a severe contusion of the chest. These patients were admitted at the department within 24 hours after the injury., Methods: The diagnosis was based on the examination of the ratio of CKMB/CK serum levels, cTnl serum level, ECG examination and echocardiography., Results: Heart contusion was diagnosed in 18 patients of the group of 103. The most precise diagnostic method proved to be the determination of the serum level of troponin I (success rate 86%) and echocardiographic examination (succes rate 67%)., Conclusions: Examination of cTnl serum level and echocardiography are the best methods for the determination of the diagnosis of heart contusion. Simultaneous application of these two methods is the most reliable diagnostic procedure. Examination of CK and CKMB serum levels produces often falsely positive results and it is not a contribution to the determination of the diagnosis of heat contusion.

Cardiac contusion is an infrequent but occasionally serious complication of deceleration injury. According to ATLS teaching, the true diagnosis of contusion can only be established by direct inspection of the myocardium. The clinically important sequelae of myocardial contusion are hypotension and arrhythmia. Despite recent advances in investigative techniques, myocardial trauma remains an important diagnostic and management challenge. This paper presents an evidence-based review of the topic.

In a 52-year-old man with new onset atrial fibrillation, transthoracic echocardiography showed an isolated, considerably dilated right ventricle. Frequent causes of right ventricular dilatation were ruled out. The image-forming investigation showed an isolated dilation of the ventral part of the heart, which, in combination with a blunt chest trauma 30 years previously, led to a previous cardiac contusion being suspected. In accordance with this hypothesis myocardial scintigraphy showed asymmetric hypertrophy of the right ventricular wall, which is consistent with the remodeling that occurs in response to injured cardiac tissue. After electrical cardioversion sinus rhythm was obtained; the patient remained symptom free.

Objective: Case reports of two patients who developed fatal cardiac arrhythmias several days after blunt chest trauma., Design: Case reports., Setting: Surgical intensive care unit of a university hospital., Patients: A 23-year-old man and a 9-year-old girl with blunt chest trauma and multiple further injuries following car crashes were transferred to our institution. Although ECG on admission was normal, both patients developed fatal cardiac arrhythmias after 6 and 4 days, respectively. In both patients, post-mortem analysis confirmed myocardial contusion without coronary artery lesions. Histological findings included severe interstitial oedema, haemorrhages and infiltration of lymphocytes and neutrophils, fresh myocardial necrosis and fatty degeneration., Conclusion: Blunt chest trauma with myocardial contusion may lead to fatal cardiac arrhythmias even after several days, particularly when other severe injuries are present. Thus, a normal ECG on admission and absence of cardiac arrhythmias during the first 24 h of intensive care treatment do not necessarily exclude the occurrence of life-threatening arrhythmias in the further course.

Background: The frequency and prognostic influence of myocardial injury in patients with blunt chest trauma is controversial. We investigated the value of cardiac troponin I (cTn-I) and cardiac troponin T (cTn-T), highly specific markers of myocardial injury, to determine whether their measurement would improve the ability to detect myocardial contusion in stable patients with blunt chest trauma in comparison with conventional markers and whether they were associated with significantly worse late clinical outcome., Methods and Results: Over an 18-month period, myocardial contusion was diagnosed in 26 of 94 patients (27.6%) with acute blunt chest trauma (motor vehicle crash; 81%), because of echocardiographic abnormalities (n = 12), electrocardiographic abnormalities (n = 29), or both. Patients with myocardial contusion had a significantly higher Injury Severity Score at the time of admission (p = 0.001) and a significantly longer hospital stay (p = 0.0008). All patients survived admission to hospital and were hemodynamically stable. None of the patients died or had severe in-hospital cardiac complications. The percentage of patients with elevated CK, (CK-MB/total CK) ratio, or CK-MB mass concentration was not significantly different between patients with or without myocardial contusion. However, there were significant differences between the two groups when we applied the commonly used threshold levels of CK-MB activity and myoglobin. The percentage of patients with elevated circulating cTn-I and cTn-T (> or = 0.1 microg/L) was significantly higher in patients with myocardial contusion (23% vs. 3%; p = 0.01 and 12% vs. 0%; p = 0.03, respectively). Complete changes in cTn-I and cTn-T correlated well (r = 0.91, p = 0.0001). Sensitivity, specificity, and negative and positive predictive values of cTn-I and cTn-T in predicting a myocardial contusion in blunt trauma patients were 23%, 97%, and 77%, 75%, and 12%, 100%, and 74%, 100%, respectively. Clinical follow-up was available in 83 patients (88%) (mean, 16 +/- 7.5 months). There were no deaths in either group directly attributed to cardiac complications. None of the patients had any long-term cardiac complications or myocardial failure related to blunt chest trauma., Conclusion: Although improved specificity of cTn-I and cTn-T compared with conventional markers, it should be emphasized that the main problem with cTn-I and cTn-T is low sensitivity as well as low predictive values in diagnosing myocardial contusion. cTn-I and cTn-T measurement is currently not an improved method in diagnosing blunt cardiac injury in hemodynamically stable patients. Moreover, there was no association of postmyocardial contusion cell injury and late outcome in these patients when cTn-I and cTn-T and other conventional markers were considered.

When patients with blunt chest trauma and suspected cardiac contusion are brought to the emergency department, focus on detecting subtle signs of myocardial dysfunction. Obtain the important first EKG, monitor for arrhythmia development, and assess for signs of failure of the right side of the heart.

A complex investigation of effectiveness of different methods of detection of heart contusion in patients with combined traumas of the chest allowed detailed elucidation of the criteria of diagnostics of heart contusions by means of electrocardiography, integral rheography of the body, ultrasonography, enzyme diagnostics. A comparative analysis has shown that none of the available now methods can be taken as absolute. The complex use of these methods only can make the maximum objective diagnosis of heart contusion. This approach allowed the authors to make the amount of diagnostic errors 18% less in patients with a combined trauma of the chest and thus to improve the results of treatment.

The efficacy of different methods of heart contusion diagnosis in patients with concomitant chest trauma was studied. Criteria of heart contusion diagnosis by electrocardiography, integral body rheography, ultrasonic diagnosis, heart enzymes analysis were covered. Comparative analysis revealed that there was no modern method with 100% diagnostic value. Only complex use of these methods permits to make objective diagnosis of heart contusion. This approach allowed to decrease diagnostic mistakes rate in patients with concomitant chest trauma by 18%.

Introduction: To evaluate within a trauma population the diagnostic value of a qualitative test (TROPT Rapid Assay) for the specific detection of circulating cardiac troponin T (cTnT) in comparison with the traditionally used CK/CK-MB ratio especially in the early in-hospital phase., Methods: Prospective study in trauma patients over a 12-month period. Multifaceted diagnostic approach to myocardial cell injury based on quantitative as well as qualitative cTnT and CK-MB/CK measurements, electrocardiographic (ECG) and echocardiographic (TTE) findings., Setting: A regional trauma centre, the Federal Armed Forces Medical Centre Ulm, Germany., Subjects: One hundred and twenty-five patients with major blunt trauma admitted to the Federal Armed Forces Medical Centre Ulm between October 1995 and November 1996., Results: The TROPT Rapid Assay results significantly correlated with the results of the quantitative cTnT determinations (P < 0.001; sensitivity 1.0 and 0. 86/specificity 0.96 and 0.94 upon hospital admission and completion of diagnostic procedures). There was no significant correlation between CK-MB/CK ratio and quantitative cTnT findings. Upon hospital admission all patients whose quantitative cTnT measurement showed a positive test result (>/= 0.2 microg/l) also had a positive TROPT Rapid Assay result (negative prediction value 1.0). There was a significant correlation of TROPT Rapid Assay results and the diagnosis of a concomitant rising "chest trauma" (P < 0.002). While a significant correlation between the TROPT Rapid Assay results and specific ECG changes was observed (P < 0.008), the findings relating to CK-MB/CK ratio did not show any significant relation to specific ECG or specific TTE changes. A significant correlation between TROPT Rapid Assay results and myocardial lesion related specific therapeutic interventions was observed (P < 0.01; specificity 1.0, sensitivity 0.11)., Conclusions: Within a multifaceted diagnostic approach to blunt cardiac trauma, cTnT should replace CK-MB as the biochemical marker of choice. The TROPT Rapid Assay is a test which rapidly and accurately enables the trauma team to differentiate patients with and without myocardial cell injury. It does not efficiently identify trauma patients at risk for the development of cardiac complications.

Based on an analysis of results of treatment of 86 patients and wounded with severe combined traumas and gunshot wounds the authors have made a diagnostic scale including 8 most significant symptoms of heart contusions which determine the index MS-HC (military surgery-heart contusion). The value of this index in scores gives a reliable picture of heart contusion. Patients having not less than 15 scores are considered to be in a critical state. Lethality among them was 80%, the survivors had complications in 45% of the cases. The autopsy showed that the diagnosis of heart contusion by the score system was correct and coincided with the autopsy findings in 94.7%. A rational program of intensive therapy for heart contusions is proposed aimed at the maintenance and development of compensatory abilities in the hemodynamic system. The basic drugs are thought to be nitroglycerin, dobutrex (dophamin), neoton. The rational surgical policy for injuries of different areas of the body, terms of its realization, indications related with different degrees of the patient's state are determined. The realization of these approaches to treatment of wounds and traumas involving contusions of the heart made lethality of such patients 27% less.

Concussion of the heart (commotio cordis) occurs in traffic accidents in which blunt force impact over the precordial area occurs, even in the absence of multiple blunt force injuries. The functional dynamics of the heart, with ventricular arrythmias and conduction disturbances, serve as the pathophysiological basis of this condition. As a cause of death in vehicular accidents, it is less common than other causes. However, it should be considered in the differential diagnosis, especially in cases with minor or no apparent injuries.