Myocardial contusion

  • Definition
    • Myocardial contusion is a bruise of the heart muscle.

  • Alternative Names
    • Blunt myocardial injury

  • Causes
    • The most common causes are:

  • Symptoms
    • A severe myocardial contusion may lead to signs and symptoms of a heart attack.

      Symptoms can include:

      • Pain in the front of the ribs or breastbone
      • Feeling that your heart is racing
      • Lightheadedness
      • Nausea or vomiting
      • Shortness of breath
      • Weakness
  • Exams and Tests
    • The health care provider will perform a physical exam. This may show:

      • Bruise or scrapes on the chest wall
      • Crunching sensation when touching the skin if there are rib fractures and puncture of the lung
      • Fast heartbeat
      • Irregular heartbeat
      • Low blood pressure
      • Rapid or shallow breathing
      • Tenderness to the touch
      • Abnormal chest wall movement from rib fractures

      Tests may include:

      These tests may show:

      • Problems with the heart wall and the ability for the heart to contract
      • Fluid or blood in the thin sac surrounding the heart (pericardium)
      • Rib fractures, lung or blood vessel injury
      • Problem with the heart's electrical signaling (such as a bundle branch block or other heart block)
      • Fast heartbeat starting at the sinus node of the heart (sinus tachycardia)
      • Abnormal heartbeat starting in the ventricles or lower chambers of the heart (ventricular dysrhythmia)
  • Treatment
    • In most cases, you will be closely monitored for at least 24 hours. An electrocardiogram (ECG) will be done continually to check your heart function.

      Emergency room treatment may include:

      • Catheter placement through a vein (IV)
      • Medicines to relieve pain, heart rate disturbances, or low blood pressure
      • Pacemaker (temporary, may be permanent later)
      • Oxygen

      Other therapies may be used to treat a heart injury, include:

      • Chest tube placement
      • Draining blood from around the heart
      • Surgery to repair blood vessels in the chest
  • Outlook (Prognosis)
    • People with a mild myocardial contusion will recover completely most of the time.

      Serious heart injuries can increase your risk for heart failure or heart rhythm problems.

  • Prevention
    • The following safety tips may help prevent a heart bruise:

      • Wear a seat belt when driving.
      • Choose a car with air bags.
      • Take steps to ensure safety when working at heights.
  • References
    • Eckstein M, Henderson SO. Thoracic trauma. In: Marx JA, Hockberger RS, Walls RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 45.

      Tsai PI, Wall MJ, Mattox KL. Traumatic heart disease. In: Mann DL, Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 10th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 72.