bubble_chart Overview

Non-penetrating cardiac injuries are mostly caused by severe impacts to the chest wall, such as a driver's chest hitting the steering wheel, sudden compression of the abdomen or lower limbs leading to a massive backflow of blood into the heart, sudden braking of a high-speed vehicle causing cardiac torsion and injury, or high-pressure airwave impacts. Based on the site of injury, they are classified as:

1. pericardial rupture, contusion,
2. myocardial rupture. These two types often coexist and should be managed as penetrating cardiac injuries.
3. Traumatic ventricular septal rupture, valve membrane rupture, chordae tendineae and papillary muscle rupture should be treated with emergency or elective open-heart repair under extracorporeal circulation as needed.
4. Myocardial contusion can range from small subepicardial or subendocardial ecchymoses to large areas of myocardial hemorrhage and immediate or delayed necrosis. It may present as: no obvious symptoms, typical substernal colicky pain, severe precordial pain radiating to the left shoulder and arm, accompanied by palpitations, dyspnea, shock, arrhythmias, etc. Therefore, only myocardial contusion and similar conditions will be discussed here.

bubble_chart Clinical Manifestations

1. History of injury, especially contusion and other closed injuries in the precordial area.
2. Minor injuries may present with no obvious symptoms, but primarily manifest as arrhythmias, such as persistent sinus tachycardia, premature contractions, and paroxysmal atrial fibrillation.
3. For grade II or higher injuries, typical substernal "colicky pain" or unbearable severe pain in the precordial area may appear immediately after the injury, 6–8 hours later, or even days to a month afterward. The pain often radiates to the left shoulder and arm and is not relieved by coronary vasodilators. It is accompanied by symptoms such as dyspnea, palpitation, shock, and hypotension.
4. Positive signs are rare, though sometimes the heart sounds may exhibit a pendulum rhythm. If combined with rupture of intracardiac structures, corresponding signs may be present.
5. Electrocardiogram findings may include ST-segment elevation, flattened or inverted T waves, and transient or persistent arrhythmias.
6. In advanced stages, color Doppler echocardiography may occasionally reveal ventricular aneurysm.

bubble_chart Diagnosis

1. Has a history of injury.
2. May or may not have the above clinical manifestations.
3. Electrocardiogram shows arrhythmia and S-T segment or T wave abnormalities.
4. Cardiac enzyme tests: such as elevated lactate dehydrogenase isoenzymes.
5. Cardiac catheterization and heart blood vessel angiography may reveal myocardial contusion areas.

bubble_chart Treatment Measures

1. Bed rest and close monitoring.
2. Prevention and treatment of infection.
3. Supportive and symptomatic treatment.
4. Prevention and treatment of heart failure.

Cardiac contusion can generally be cured with conservative treatment. However, for those with long-term abnormal S-T segment and T wave changes on electrocardiogram, Doppler color echocardiography should be performed to exclude ventricular aneurysm. If the presence of ventricular aneurysm is confirmed, repair should be performed under extracorporeal circulation.

bubble_chart Cure Criteria

1. Cure: Cardiac function restored to grade I or above, able to perform physical labor without discomfort, and ECG examination shows normal results.
2. Improvement: Cardiac function restored to grade II or below, able to perform general physical labor, but ECG still shows abnormalities.