A rational screening and treatment strategy based on the electrocardiogram alone for suspected cardiac contusion

Article Abstract:

Blunt chest injury can cause contusion of the myocardium, or heart muscle. It is now believed that if the patient is hemodynamically stable, this injury is not life-threatening. Cardiac contusion results in easily controlled electrical instability of the heart and, occasionally, in temporarily decreased cardiac output. There is evidence suggesting that the initial electrocardiogram (EKG; recording of the heart's electrical activity) may be the best method of screening for this injury. A retrospective study was undertaken to determine the usefulness of the electrocardiogram as a screening tool. The medical records of 71 patients were reviewed; all patients had been admitted for possible cardiac contusion. A second group of medical records of 61 patients with possible cardiac contusion and more severe injuries was also reviewed. Only 13 patients developed heart problems related to contusion; all 13 patients had changes on their electrocardiograms while being evaluated in the Emergency Room. Of 12 patients who had creatine phosphokinase-MB fractions obtained, 5 had normal results; of 9 patients who had echocardiograms performed, 5 had normal results. All patients who had normal EKG's were free of subsequent cardiac problems. It is concluded that if the EKG had been used as the only screening tool, 25 percent of the patients could have been safely discharged directly from the Emergency Room rather than admitted to the hospital. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Evaluation, Electrocardiogram, Electrocardiography, Medical screening, Health screening

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Early detection of myocardial contusion and its complications in patients with blunt trauma

Article Abstract:

Myocardial contusion (bruise or injury without bleeding to the muscle of the heart) is a potentially lethal complication of blunt injury to the chest. It is very difficult to identify this condition. When it is suspected, treatment requires close heart and blood-flow monitoring so that complications are detected early. A method of properly identifying patients at risk for myocardial contusion is needed. A retrospective study was undertaken to identify factors and information available at the time of admission that distinguish patients at high risk for myocardial contusion. Records of all patients with suspected myocardial contusion were studied. Of 88 patients evaluated, 27 were confirmed with myocardial contusion. Diagnostic confirmation included electrocardiogram (EKG) consistent with acute injury, elevation of creatinine kinase-MB (CPK-MB), or abnormal echocardiogram consistent with acute injury. Patients with confirmed contusion had abnormal EKGs and an Injury Severity Score (method of quantifying severe trauma) of greater than 10. Multivariate analysis revealed that these two factors were predictive of myocardial contusion. When these two factors were not observed, there was only a 1 percent probability of myocardial contusion. This study showed that 40 percent (35 of 88 patients) did not benefit from intense cardiac monitoring. A prospective study using these variables is recommended. (Consumer Summary produced by Reliance Medical Information, Inc.)

Wounds and injuries, Heart

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