Blunt cardiac injury: a 10 year institutional review

A 10 year review of all blunt cardiac injuries ( N = 70) at a single trauma institution was conducted. The majority of patients were diagnosed on the basis of elevated myocardial band fraction of creatine kinase (CK-MB), ST/T wave changes or arrhythmias. The presence of CK-MB elevation was not predictive of arrhythmias, cardiac complications, inotrope requirement, or mortality. The presence of ECG abnormalities or arrhythmias was also not predictive of inotrope requirement or mortality. Cardiac complications requiring treatment occurred in 26 per cent ( N = 18) of patients. Patients requiring inotropes ( N = 12, 17 per cent) had higher Injury Severity Scores (ISS), longer times from injury to emergency, and higher mortality rates, than those not requiring them. Patients who died ( N = 10) had a higher ISS, lower Revised Trauma Score, and a more frequent need for inotropes. Only three deaths were directly attributable to the cardiac injury. Myocardial contusion is an injury often of little clinical importance. Patients present with injuries of little or no consequence, severe injuries where the diagnosis is readily apparent, or as a confounding variable in a multiply injured patient. Early use of transthoracic echocardiography is advocated.