![]() ![]() The aortic valve is most commonly involved, followed by the mitral. ![]() Valve injuries are equally infrequent and are due to compressive forces of blood during contraction that leads to valve, chordae tendinae, and papillary muscle rupture. Sequelae from such injuries may be devastating, and can include myocardial infarction, production of emboli, arrhythmia, ventricular failure, and delayed ventricular rupture. This occurs almost always in conjunction with severe myocardial contusion, usually involving the left anterior descending artery as it lies anterior in the chest beneath the sternum. Alternatively, severe abdominal compression can lead to rapid increase in blood flow to the heart from the inferior vena cava with chamber rupture due to a sudden increase in intracardiac pressure.īlunt coronary artery injuries are exceedingly rare but may occur with direct impact leading to intimal disruption and thrombosis. Other mechanisms, such as falls, crush injuries, assault, and sports related injuries with direct blows to the chest also contribute. This is seen most frequently in motor vehicle crashes and cases of pedestrians struck by motor vehicles. Mechanism of Injuryīecause the heart is well encompassed within the bony thorax comprised of ribs and sternum, it requires significant force to cause BCI. Septal, coronary artery, and valve injuries occur even more rarely, with only a few case reports documented in the literature. RV injury and RA injury are more common (17-32% and 8-65%, respectively), whereas left sided lesions are less frequent (LV~ 8-15%, LA 0-31%). The distribution of injury amongst the different heart chambers relates to the anterior positioning of the right sided chambers in the chest. In 2004 Schultz et al found myocardial contusion to be the most commonly reported blunt cardiac injury (60-100%). This may suggest either that subtler forms of cardiac injury are underdetected when symptoms are minimal, or that many patients with significant BCI die in the field from cardiac or associated traumatic injury. ![]() Clinical studies looking at BCI in chest and abdominal trauma report incidences significantly lower than in autopsy series. Although it occurs in only 20% of all blunt thoracic trauma patients, in patients with severe thoracic injury or multiple injuries, the incidence of BCI may be as high as 76%. Blunt cardiac injury is involved in up to 20% of all motor vehicle collision deaths. The true incidence of BCI is unknown as reported rates vary greatly in the literature, ranging anywhere between 8 and 71%. Treatment is tailored to the severity of injury and ranges from EKG monitoring to sternotomy with complex surgical repair. The absence of a clear definition and gold standard for laboratory testing make the diagnosis of blunt cardiac injury difficult. The manifestations of such range from clinically silent, transient arrhythmias to deadly cardiac wall rupture.
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