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Myocardial contusion
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Myocardial contusion

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Blunt myocardial injury

Myocardial contusion is a bruise of the heart muscle.

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  • Causes

    The most common causes are:

    • Car crashes
    • Getting hit by a car
    • Cardiopulmonary resuscitation (CPR)
    • Falling from a height, most often greater than 20 feet
  • 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
    • Light-headedness
    • Nausea or vomiting
    • Shortness of breath
    • Weakness
  • Exams and Tests

    The doctor or nurse 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:

    • Blood tests (cardiac enzymes, such as Troponin-I or T or CKMB)
    • Chest x-ray
    • CT scan of the chest
    • Electrocardiogram (ECG or EKG)
    • Echocardiogram

    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 heart beat starting at the sinus node of the heart (sinus tachycardia)
    • Abnormal heart beat 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)
    • Medications 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.

Related Information

  Muscle cramps    

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: Mosby Elsevier; 2013:chap 45.

Jones RF, Rivers EP. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Saunders Elsevier; 2013:chap 18.

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Review Date: 5/13/2014  

Reviewed By: Michael A. Chen, MD, PhD, Associate Professor of Medicine, Division of Cardiology, Harborview Medical Center, University of Washington Medical School, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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