Harvey's Garden

Blunt Cardiac Injury

2 min read

  • Epidemiology & Risk Factors

    • High-energy blunt thoracic trauma (e.g., MVA steering wheel impact).
    • Right ventricle (RV) most commonly injured (anterior position).

  • Clinical Features

    • Sternal/anterior chest pain.
    • Tachycardia out of proportion to volume status/pain.
    • Arrhythmias (PVCs most common, AFib, RBBB).
    • Hypotension/cardiogenic shock (if RV/LV failure or rupture).

  • Diagnosis

    • Initial/Screening: ECG + Cardiac Troponin.
      • 12-lead ECG: Sinus tachycardia is the most common finding. May show new arrhythmias (PVCs, AFib), conduction blocks (RBBB), or ST-T wave changes.
      • High-yield concept: If both ECG & Trop are NORMAL, BCI is virtually ruled out (100% NPV).
    • Key Imaging: CXR (rib/sternal fractures), eFAST (rule out tamponade).
    • Confirmatory/Best Test: Echocardiogram (TTE). Indicated ONLY IF ECG/Trop are abnormal or pt is unstable. Shows focal wall motion abnormalities.

  • Differential Diagnostics

    • Traumatic Aortic Rupture: Diff by widened mediastinum on CXR. Confirm w/ CTA Chest.
    • Tension PTX: Diff by absent breath sounds, tracheal deviation, hyperresonance.
    • Cardiac Tamponade: Can be secondary to BCI. Diff by Beck’s triad, distended neck veins, +FAST.

  • Management

    1. Normal ECG & Trop: No cardiac monitoring required; manage other trauma.
    2. Abnormal ECG or ↑ Trop: Admit for continuous telemetry x 24-48h (high risk for fatal arrhythmias).
    3. Hemodynamic Instability:
      • Careful IVF (injured RV is highly sensitive to volume overload).
      • Inotropes (e.g., dobutamine) for cardiogenic shock.
    4. Structural Damage: Urgent CT Surg consult (for valvular rupture/VSD).

  • Complications

    • Fatal arrhythmias (VT/VF).
    • Ventricular free wall rupture → acute tamponade.
    • Traumatic VSD or valvular regurgitation.

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