title: Cardiac contusion following blunt chest trauma.
abstract: Cardiac contusion following blunt chest trauma is not rare, and the works in the literature report incidence rates between 5 and 50%. Traffic accidents are the most frequent cause of cardiac contusion followed by violent fall impacts, aggressions and the practice of risky sports. The spectrum of post-traumatic cardiac lesions varies greatly, ranging from no symptoms to decrease in cardiac function. Cardiogenic shock is a rarely encountered manifestation of blunt cardiac contusion. We review our experience of cardiac contusion after blunt chest trauma, and we describe two very severe cases that manifested as cardiogenic shock. We emphasize an early diagnosis by continuous electrocardiographic monitoring, serial electrocardiograms, echocardiography, serum determination of biochemical cardiac markers, radionuclide imaging and coronary angiography. The treatment includes continuous monitoring of cardiac rhythm, use of inotropic drugs, insertion of a catheter in the pulmonary artery for continuous assessment of cardiac output and, in extreme cases, the insertion of a contrapulsation balloon to maintain haemodynamics until improvement of cardiac function.
authors.affiliation: Department of Intensive Care Medicine, Unit of Multisystem Trauma, The Marqués de Valdecilla Hospital of Santander, Cantabria, Spain. sholanda@humv.es
authors.forename: María S
authors.initials: MS
authors.lastname: Holanda
authors.forename: María J
authors.initials: MJ
authors.lastname: Domínguez
authors.forename: Francisco
authors.initials: F
authors.lastname: López-Espadas
authors.forename: Marta
authors.initials: M
authors.lastname: López
authors.forename: Jenaro
authors.initials: J
authors.lastname: Díaz-Regañón
authors.forename: Juan C
authors.initials: JC
authors.lastname: Rodríguez-Borregán
mesh_terms: D000058:Accidental Falls; D000062:Accidents, Occupational; D000063:Accidents, Traffic; D000328:Adult; D001265:Athletic Injuries / Q000150:complications; D002302:Cardiac Output; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002407:Catheterization, Swan-Ganz; D015984:Causality; D003288:Contusions / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D017023:Coronary Angiography; D015908:Counterpulsation; D042241:Early Diagnosis; D004562:Electrocardiography; D004638:Emergency Treatment / Q000379:methods*; D006335:Heart Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D012770:Shock, Cardiogenic / Q000209:etiology; D013898:Thoracic Injuries / Q000150:complications
chemical_list: D002316:Cardiotonic Agents