Alternative Names traumatic heart disease, blunt trauma to the chest, non-penetrating chest injury
Definition Injuries to the chest wall can be classified into two general groups. Penetrating injuries are wounds in which the chest cavity is pierced, such as knife stabbings or gunshot wounds. Non-penetrating injuries involve crush injuries or compression of the chest. This type of injury is often a result of motor vehicle accidents or explosions. Alone or in combination, these forces can cause a contusion or bruising of heart. This can weaken the heart muscle.
What is going on in the body? A severe blow to the chest can cause damage to the muscle of the heart. This is commonly seen after a motor vehicle accident. Injuries to heart can be severe even if there is no external sign of chest trauma. Effects of this type injury can include:
bleeding within the heart muscle
weakening of the heart muscle
areas of heart muscle death
rupture of the heart chamber walls and associated structures
irregular heart rhythms, called arrhythmias, which can sometimes be fatal
problems with the transmission of the electrical impulses that control heart beat, called conduction problems
bleeding into the membrane that surrounds the heart, which can cause cardiac tamponade
What are the signs and symptoms of the condition? Chest pain similar to a heart attack commonly occurs with this condition. Also, Shortness of breath and difficulty breathing may indicate congestive heart failure. This is a condition where the heart's decreased pumping ability causes fluid to back up into the lungs. A physical examination may not reveal signs that indicate the severity of the injury.
Heart murmurs may be heard as blood is pumped through damaged valves. Heart sounds may seem distant if fluid and blood accumulates around the heart. If the heart lining was damaged, a characteristic scratching or rubbing sound called a friction rub can be heard. Fluid in the lungs, known as pulmonary oedema, may be heard if heart failure is severe or if the lungs were injured.
What are the causes and risks of the condition? Motor vehicle accidents are a common cause of myocardial contusion. The injury can occur when the driver bangs into the steering wheel. It can also result from falls and crush injuries. The sudden deceleration caused by these injuries creates sudden tearing forces on the body that contribute to the damage. This can be seen in motor vehicle accidents as passengers get tossed about the car.
What can be done to prevent the condition? Accidents can not be prevented. However, the use of seat belts alone or in combination with air bags can help to prevent injury. Also, appropriate safety equipment should be used for other types of tasks that could result in chest injury. Driving and other potentially dangerous tasks should never be attempted under the influence of alcohol or drugs.
How is the condition diagnosed? A person is suspected of having this condition if he or she has chest symptoms and has been in a motor vehicle accident at speeds of 60kph or greater. Any sort of chest injury, even it is seemingly minor, should be reported to the doctor. Many times, problems don't appear for days to weeks after an injury. A physical examination is not always sufficient to reveal the full scope of the problem. An electrocardiogram (ECG) is sometimes used to look for abnormalities such as arrhythmias, conduction problems and indications of damage to the pericardium. An ultrasound of the heart, called an echocardiogram can be used to assess the structure and function of the heart.
What are the long-term effects of the condition? A person who survives the initial accident may develop complications in the weeks that follow. These can include:
fluid in the membrane around the heart, called pericardial effusion
traumatic aneurysm, which is a tear in the aorta into which blood can flow and weaken or burst the vessel
What are the risks to others? There are no risks to others.
What are the treatments for the condition? The goal of treatment is to control the symptoms. Treatments vary depending on how the heart has been damaged. Medications are used to correct irregular beating, or arrhythmias, of the lower chambers of the heart, called the ventricles. Untreated arrhythmias can be potentially life threatening. Interruption of the electrical impulses that make the heart beat may need to be corrected with a temporary pacemaker. Surgery may be needed to repair ruptures or tears in the heart muscle or aneurysms. Draining blood and fluid from the pericardium may be necessary to relieve pressure that could stop the flow of blood to the heart. Medications to relieve pain and inflammation are also used to treat myocardial contusion.
What are the side effects of the treatments? All medications have associated side effects. Some may worsen arrhythmias and conduction problems. Surgery carries the risks of bleeding, infection, and death. Myocardial contusion leading to rupture of an aneurysm or wall of the heart is associated with a high risk of death from the surgery.
What happens after treatment for the condition? Most individuals with myocardial contusions are able to slowly return to their normal activities after a period of bed rest.
How is the condition monitored? A person with a myocardial contusion will need follow up visits to the doctor because complications can appear weeks after the injury. shortness of breath or other unusual symptoms should be reported to the doctor immediately.
Author: Eric Berlin, MD Reviewer: HealthAnswers Australia Medical Review Panel Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia Last Updated: 1/10/2001 Contributors Potential conflict of interest information for reviewers available on request
