Outcome of serious blunt cardiac injury.

Abstract

Although serious blunt cardiac injury (BCI) is usually fatal, patients who reach the hospital alive can have a spectrum of abnormalities. We attempted to define the clinical features that helped identify serious BCI and to evaluate outcome. Patients with serious BCI at a level I trauma center were identified during a 3-year period. Twelve patients had serious BCI. Six patients had cardiac arrest, and six had unexplained hypotension. Specific injuries included acute myocardial rupture (two patients); valvular disruption (two); myocardial contusion associated with either cardiac failure (two), complex ventricular arrhythmias (two), or delayed myocardial rupture (one), or present at autopsy (two); and coronary artery thrombosis (one). Seven of eight patients who did not have associated fatal injuries survived. Electrocardiography suggested cardiac injury in all nine patients in whom it was done, and echocardiography was useful to establish the diagnosis in four of five patients. Creatine phosphokinase isoenzyme levels did not distinguish serious injuries. The outcome of serious blunt cardiac injury can be favorable if patients have signs of life on arrival at the hospital, the signs of injury are recognized promptly, and other injuries do not supervene.