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 accidents or explosions. Alone or in combination, these forces can cause a myocardial contusion.
A myocardial contusion may have the following effects:
bleeding into the membrane that surrounds the heart, which can cause cardiac tamponade
bleeding within the heart muscle
conduction problems, or an abnormality in the transmission of the electrical impulses that control the heartbeat
congestive heart failure, a condition in which the heart’s decreased pumping ability causes fluid to back up into the lungs
damage to heart valves
death of areas of heart muscle
rupture of the heart chamber walls and nearby structures
weakening of the heart muscle
What are the causes and risks of the condition?
Motor vehicle accidents 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.
Symptoms & Signs
What are the signs and symptoms of the condition?
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 heartbeats
severe chest pain
shortness of breath
Diagnosis & Tests
How is the condition diagnosed?
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 don’t appear for days or even weeks after an injury.
The healthcare provider may order these tests:
blood tests, including serial troponin and creatine phosphokinase, or CPK, levels
an echocardiogram, or ultrasound of the heart, to check the structure and function of the heart
an electrocardiogram, or EKG, to look for arrhythmias and conduction problems
Prevention & Expectations
What can be done to prevent the condition?
Accidents 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.
What are the long-term effects of the condition?
A person who survives the initial accident may develop complications in the weeks that follow. These can include:
arrhythmias that can be fatal if left untreated
congestive heart failure
traumatic aneurysm, which is a tear in the aorta
What are the risks to others?
A myocardial contusion is not contagious. It poses no risk to others.
Treatment & Monitoring
What are the treatments for the condition?
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 arrhythmias
medicines to relieve pain and inflammation
placement of a temporary pacemaker to correct conduction problems
a procedure to drain blood and fluid from the pericardium to relieve pressure
surgery to repair aneurysms, or tears in the heart muscle
What are the side effects of the treatments?
All medicines have associated side effects. Some may worsen arrhythmias and conduction problems. Surgery may cause bleeding, infection, or allergic reaction to anesthesia.
What happens after treatment for the condition?
Most people who have a myocardial contusion are able to slowly return to their normal activities after a period of bed rest.
How is the condition monitored?
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