Blunt Cardiac Injury (BCI)
Blunt Cardiac Injury (BCI)
David Ray Velez, MD
Table of Contents
Background
Formerly Known as “Cardiac Contusion”
Definition: Cardiac Injury Caused by Blunt Force Trauma to the Chest
Causes
- Motor Vehicle Crash (MVC) – Most Common (50%)
- Falls
- Blast Injury
- Assault
- Any Other Blunt Mechanism
Most Common Symptoms: Chest Pain and Shortness of Breath
Complications
- Arrhythmia – Most Common Complication
- Sinus Tachycardia is the Most Common Arrhythmia
- Often See PAC’s or PVC’s
- Ventricular Rupture
- Valve Disruption (Aortic Most Common)
- Pericardial Effusion
- Cardiac Tamponade
- Coronary Artery Injury
- Myocardial Ischemia
- Constrictive Pericarditis
Sternal Fracture is Not Predictive of Blunt Cardiac Injury (3.6% Incidence)
Screening
Initial Screen: EKG
- If Stable and EKG Normal: Troponin
- If Unstable or EKG Abnormal: Echocardiogram and Telemetry
- Transesophageal Echo (TEE) May Be Preferred Over Transthoracic Echo (TTE) if Available
Normal ECG and Troponin Essentially Rules Out BCI
Screening with No Benefit: CK-MB, CPK, and Nuclear Imaging
Management
Primary Treatment
- Mostly Supportive Management
- Monitor with Telemetry in the ICU
- Cardiology Consultation
Adjunctive Measures
- Fluid Resuscitation
- Vasopressor Support and Inotropes
- Intra-Aortic Balloon Pump (IABP)
- Myocardial Infarction May Require Coronary Angiography
- Structural Injury May Require Surgical Intervention