Diagnosis: heart contusion?
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KeywordsBlunt Trauma Transesophageal Echocardiography Myocardial Damage Cardiac Injury Multiple Trauma
Myocardial contusion can result from blunt thoracic trauma and is commonly suspected in deceleration injuries. Unfortunately, traumatic heart disease is frequently overlook and the diagnosis of myocardial contusion is often unrecognized. Also the frequency and prognostic influence of cardiac injury in patient with blunt trauma is contraversial. Myocardial contusion is reported to be present in as few as 0% of patients and as many as 76% with blunt chest trauma depending on the criteria used for establishing the diagnosis.
Diagnosing myocardial damage as a result of trauma may be a problem because there is a lack of a gold standard for establishing the diagnosis.
More articles brought no clear results about specifity and signification of these methods. The conventional CKMB activity and CKMB/CK-total ratio are still used in our country even if low specifity of these markers has been demonstrated, especially in American literature. On the contrary echocardiography (and particularly transesophageal echocardiography) is still not fully used and in many hospitals is not accessible at all.
The group of 101 patients hospitalized in traumatology and general ICUs (1998–2000) with diagnosis: multiple trauma (including trauma of chest) or isolated thoracic trauma. The only including criterion — admission to our ICU within 24 hours from the injury. We have tried to determine the incidence of heart contusion and to compare all accessible methods of diagnosis and its importance. The aim of this study was to assess the validity of diagnostic procedures and possibility of its simplification.
The Figure demonstrates that validity of CK-MB/CK-total ratio is very low. Also changes of ECGs are not specific. Values of troponin I and results of TTE are mostly correlating and are the most conclusive for diagnosis. For these patients assessment of CK-MB/CK is useless and brings higher economic charges.