Myocardial contusion refers to a bruising of the heart. It is usually due to an injury to the chest wall.
Injuries to the chest wall can be placed into two general groups. Penetrating injuries are wounds in which the chest cavity is pierced. Two examples are knife stabbings and gunshot wounds.
Nonpenetrating injuries involve crush injuries, or compression of the chest. This type of injury is often a result of motor vehicle or motorcycle crashes or explosions.
Alone or in combination, these forces can cause a myocardial contusion.
A myocardial contusion may have the following effects: bleeding into the pericardial sac (the membrane that surrounds the heart), which can cause cardiac tamponadebleeding within the heart muscleabnormalities in the transmission of the electrical impulses that control the heartbeatcongestive heart failure, a condition in which the heart's decreased pumping ability causes fluid to back up into the lungsdamage or rupture of the heart valvesdeath of areas of heart musclerupture of the heart chamber walls and nearby structuresweakening of the heart muscle
Injuries to the heart can be severe even if there is no external sign of chest trauma. Signs and symptoms can include: arrhythmias, or irregular heartbeatssevere chest painshortness of breath
Motor vehicle crashes are a common cause of myocardial contusion. The injury can occur when the driver bangs into the steering wheel. Falls and crush injuries can also cause a contusion. The sudden deceleration caused by these injuries creates sudden tearing forces on the body that contribute to the damage.
Motor vehicle crashes can not always be prevented. However, seat belts used alone or with air bags can help to prevent injury. Also, the right 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 done under the influence of alcohol or drugs. Following sports safety guidelines for children, adolescents, and adults may prevent some injuries.
Diagnosis of myocardial contusion begins with a medical history and physical exam. Any chest injury, even if it appears to be minor, should be reported to the healthcare provider. Diagnosing myocardial contusion can be very difficult. Many times, problems do not appear for days or even weeks after an injury.
The healthcare provider may order these tests: blood tests, including serial troponin (a cardiac protein that is not normally seen in the bloodstream unless there is cardiac damage) and creatine phosphokinase, or CPK, levelsan echocardiogram, (ultrasound of the heart), or if available, cardiac MRI to check the structure and function of the heartan electrocardiogram, or ECG, to look for arrhythmias and conduction problems
A person who survives the initial trauma may develop complications in the weeks that follow. These can include: arrhythmias that can be fatal if left untreatedcardiac tamponade (collection of fluid within the sac that prevents the heart from filing and contracting)congestive heart failurepericardial effusiontraumatic aneurysm (a tear in the aorta)
A myocardial contusion is not contagious. It poses no risk to others.
The goal of treatment is to control the symptoms. Treatments vary depending on how the heart has been damaged. Following are some common treatments: medicines to correct arrhythmiasmedicines to relieve pain and inflammationplacement of a temporary pacemaker to correct conduction problemsa procedure to drain blood and fluid from the pericardium to relieve pressuresurgery to repair aneurysms, or tears in the heart muscle
All medicines may have associated side effects. Some may worsen arrhythmias and conduction problems. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.
Most people who have a myocardial contusion are able to return gradually to their normal activities after a period of bed rest.
A person who has a myocardial contusion will need follow-up visits to the healthcare provider because complications can appear weeks after the injury. Any new or worsening symptoms should be reported to the healthcare provider.
Merck Manual 1999
Harrison's Principles of Internal Medicine 1991
Heart Disease: A Textbook of Cardiovascular Medicine, 1980