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Cardiac Contusion: The Effect on Operative Management of the Patient With Trauma Injuries

Cardiac Contusion: The Effect on Operative Management of the Patient With Trauma Injuries Abstract • Sixty-four patients with cardiac contusion documented by electrocardiographic changes and creatine kinase MB fraction assay following blunt chest injury were reviewed to assess the impact of cardiac contusion on subsequent management. Fifty-eight patients had elevated creatine kinase MB levels; 35 patients had electrocardiographic abnormalities, including ST-segment and T-wave changes (25), premature ventricular contraction (ten), right bundle-branch block (nine), atrioventricular block (three), atrial fibrillation (three), and premature atrial contraction (two). Thirty patients underwent general anesthesia. There were only four perioperative complications: ventricular ectopy, ventricular fibrillation, nodal rhythm, and pulmonary edema. There were no deaths attributable to cardiac contusion. In summary, patients with blunt trauma who have sustained a cardiac contusion can undergo elective operation with a low incidence of complication. In the emergency setting, however, hemodynamic monitoring for early detection of arrhythmias is indicated. (Arch Surg 1989;124:506-507) References 1. Parmley LF, Manion WC, Mattingly TW: Nonpenetrating traumatic injury of the heart . Circulation 1958;18:371-396.Crossref 2. Symbas PN: Cardiac trauma . Am Heart J 1976;92:387-396.Crossref 3. Saunders CR, Doty SB: Myocardial contusion . Surg Gynecol Obstet 1977;144:595-603. 4. Beck CS: Contusions of the heart . JAMA 1935;104:109-114.Crossref 5. Bright EF, Beck CS: Nonpenetrating wounds of the heart . Am Heart J 1935;10:293-321.Crossref 6. Lindsey D, Navin TR, Finley PR: Transient elevation of serum activity of MB isoenzyme of creatinine phosphokinase in drivers involved in automobile accidents . Chest 1978;74:15-18.Crossref 7. Viano DC, Artinian CG: Myocardial conducting system dysfunctions from thoracic impact . J Trauma 1978;18:452-459.Crossref 8. Michelson WB: CPK-MB isoenzyme determinations: Diagnostic and prognostic value in elevation of blunt chest trauma . Ann Emerg Med 1980; 9:562-567.Crossref 9. Sutherland GR, Calvin JE, Driedger AA, et al: Anatomic and cardiopulmonary responses to trauma with associated blunt chest injury . J Trauma 1981;21:1-22.Crossref 10. Miller FA, Seward JB, Gersh BJ, et al: Two-dimensional echocardiographic findings in cardiac trauma . Am J Cardiol 1982;50:1022-1027.Crossref 11. Rodriguez A, Shatney C: The value of technetium99m pyrophosphate scanning in the diagnosis of myocardial contusion . Ann Surg 1982;48:472-474. 12. King RM, Mucha P, Seward JB, et al: Cardiac contusion: A new diagnostic approach utilizing two dimensional echocardiography . J Trauma 1983;23:610-614.Crossref 13. Kumar SA, Puri VK, Mittal VK, et al: Myocardial contusion following nonfatal blunt chest trauma . J Trauma 1983;23:327-333.Crossref 14. Harley DP, Mena I, Narahara KA, et al: Traumatic myocardial dysfunction . J Thorac Cardiovasc Surg 1984;87:386-393. 15. Cane RD, Schamroth L: Prolongation of the Q-T interval with myocardial contusion . Heart Lung 1975;7:652-656. 16. Liedtke AJ, Allen RP, Nellis SH: Effects of blunt cardiac trauma on coronary vasomotion, perfusion, myocardial mechanics and metabolism . J Trauma 1980;20:777-785.Crossref 17. Stein PD, Sabah HN, Viano DC, et al: Response of the heart to nonpenetrating cardiac trauma . J Trauma 1982;22:364-373.Crossref 18. DeGroot M, Prewitt RM: Right ventricular contusion: Experimental pathophysiology and treatment in an open heart canine preparation . J Trauma 1984;24:721-727.Crossref 19. Potkin RT, Werner JA, Trobaugh GB, et al: Evaluation of noninvasive tests of cardiac damage in suspected cardiac contusion . Circulation 1982; 66:627-631.Crossref 20. Lozman J, Sero SC, Feastel PJ, et al: Pulmonary and cardiovascular consequences of immediate fixation or conservative management of long bone failures . Arch Surg 1986;121:992-999.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Cardiac Contusion: The Effect on Operative Management of the Patient With Trauma Injuries

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References (22)

Publisher
American Medical Association
Copyright
Copyright © 1989 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1989.01410040116027
Publisher site
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Abstract

Abstract • Sixty-four patients with cardiac contusion documented by electrocardiographic changes and creatine kinase MB fraction assay following blunt chest injury were reviewed to assess the impact of cardiac contusion on subsequent management. Fifty-eight patients had elevated creatine kinase MB levels; 35 patients had electrocardiographic abnormalities, including ST-segment and T-wave changes (25), premature ventricular contraction (ten), right bundle-branch block (nine), atrioventricular block (three), atrial fibrillation (three), and premature atrial contraction (two). Thirty patients underwent general anesthesia. There were only four perioperative complications: ventricular ectopy, ventricular fibrillation, nodal rhythm, and pulmonary edema. There were no deaths attributable to cardiac contusion. In summary, patients with blunt trauma who have sustained a cardiac contusion can undergo elective operation with a low incidence of complication. In the emergency setting, however, hemodynamic monitoring for early detection of arrhythmias is indicated. (Arch Surg 1989;124:506-507) References 1. Parmley LF, Manion WC, Mattingly TW: Nonpenetrating traumatic injury of the heart . Circulation 1958;18:371-396.Crossref 2. Symbas PN: Cardiac trauma . Am Heart J 1976;92:387-396.Crossref 3. Saunders CR, Doty SB: Myocardial contusion . Surg Gynecol Obstet 1977;144:595-603. 4. Beck CS: Contusions of the heart . JAMA 1935;104:109-114.Crossref 5. Bright EF, Beck CS: Nonpenetrating wounds of the heart . Am Heart J 1935;10:293-321.Crossref 6. Lindsey D, Navin TR, Finley PR: Transient elevation of serum activity of MB isoenzyme of creatinine phosphokinase in drivers involved in automobile accidents . Chest 1978;74:15-18.Crossref 7. Viano DC, Artinian CG: Myocardial conducting system dysfunctions from thoracic impact . J Trauma 1978;18:452-459.Crossref 8. Michelson WB: CPK-MB isoenzyme determinations: Diagnostic and prognostic value in elevation of blunt chest trauma . Ann Emerg Med 1980; 9:562-567.Crossref 9. Sutherland GR, Calvin JE, Driedger AA, et al: Anatomic and cardiopulmonary responses to trauma with associated blunt chest injury . J Trauma 1981;21:1-22.Crossref 10. Miller FA, Seward JB, Gersh BJ, et al: Two-dimensional echocardiographic findings in cardiac trauma . Am J Cardiol 1982;50:1022-1027.Crossref 11. Rodriguez A, Shatney C: The value of technetium99m pyrophosphate scanning in the diagnosis of myocardial contusion . Ann Surg 1982;48:472-474. 12. King RM, Mucha P, Seward JB, et al: Cardiac contusion: A new diagnostic approach utilizing two dimensional echocardiography . J Trauma 1983;23:610-614.Crossref 13. Kumar SA, Puri VK, Mittal VK, et al: Myocardial contusion following nonfatal blunt chest trauma . J Trauma 1983;23:327-333.Crossref 14. Harley DP, Mena I, Narahara KA, et al: Traumatic myocardial dysfunction . J Thorac Cardiovasc Surg 1984;87:386-393. 15. Cane RD, Schamroth L: Prolongation of the Q-T interval with myocardial contusion . Heart Lung 1975;7:652-656. 16. Liedtke AJ, Allen RP, Nellis SH: Effects of blunt cardiac trauma on coronary vasomotion, perfusion, myocardial mechanics and metabolism . J Trauma 1980;20:777-785.Crossref 17. Stein PD, Sabah HN, Viano DC, et al: Response of the heart to nonpenetrating cardiac trauma . J Trauma 1982;22:364-373.Crossref 18. DeGroot M, Prewitt RM: Right ventricular contusion: Experimental pathophysiology and treatment in an open heart canine preparation . J Trauma 1984;24:721-727.Crossref 19. Potkin RT, Werner JA, Trobaugh GB, et al: Evaluation of noninvasive tests of cardiac damage in suspected cardiac contusion . Circulation 1982; 66:627-631.Crossref 20. Lozman J, Sero SC, Feastel PJ, et al: Pulmonary and cardiovascular consequences of immediate fixation or conservative management of long bone failures . Arch Surg 1986;121:992-999.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Apr 1, 1989

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