Myocardial Contusion

Basics

Also known as blunt cardiac injury
Pathologically characterized by discrete and well-demarcated area of hemorrhage
Usually subendocardial
May extend in pyramidal transmural fashion
Most commonly involves anterior wall of right ventricle or atrium due to anatomic location

Blunt trauma to chest:
- High-speed deceleration accidents
- May occur in accidents with speeds as low as 20–35 mph
Auto–pedestrian injuries
Falls
Prolonged closed-chest cardiac massage
Heart may be compressed between sternum and vertebrae
Heart strikes sternum during deceleration
Heart is damaged by abdominal viscera upwardly displaced by force on abdomen
Concussive forces (e.g., explosion)
Associated conditions:
- Life-threatening dysrhythmias
- Cardiogenic shock/CHF
- Hemopericardium with tamponade
- Valvular/myocardial rupture
- Intraventricular thrombi
- Thromboembolic phenomena
- Coronary artery occlusion from intimal tearing or adjacent hemorrhage and edema may rarely occur

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