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Definition:
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Myocardial contusion is a bruise of the heart muscle.
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Alternative Names:
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Blunt myocardial injury
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Causes, incidence, and risk factors:
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The most common causes are:
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Symptoms:
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A severe myocardial contusion may lead to signs and symptoms of a heart attack.
Symptoms can include:
- Pain in the front of the ribs or breastbone
- Feeling that your heart is racing
- Light-headedness
- Nausea or vomiting
- Shortness of breath
- Weakness
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Signs and tests:
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The doctor or nurse will perform a physical exam. This may show:
- Bruise or scrapes on the chest wall
- Crunching sensation when touching the skin, if there are rib fractures and puncture of the lung
- Fast heartbeat
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Irregular heartbeat
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Low blood pressure
- Rapid or shallow breathing
- Tenderness to the touch
- Abnormal chest wall movement from rib fractures
Tests may include:
These tests may show:
- Problems with the heart wall and the ability for the heart to contract
- Fluid or blood in the thin sac surrounding the heart (pericardium)
- Rib fractures, lung or blood vessel injury
- Problem with the heart's electrical signaling (such as a bundle branch block or other heart block)
- Fast heart beat starting at the sinus node of the heart (sinus tachycardia)
- Abnormal heartbeast starting in the ventricls or lower chambers of the heart (ventricular dysrhythmia)
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Treatment:
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You will be closely monitored for 24 hours. An electrocardiogram (ECG) will be done continually to check your heart function.
Emergency room treatment may include:
- Catheter placement through a vein (IV)
- Medications to relieve pain, heart rate disturbances, or low blood pressure
- Pacemaker (temporary, may be permanent later)
- Oxygen
Other therapies may be used to treat a heart injury, include:
- Chest tube placement
- Draining blood from around the heart
- Surgery to repair blood vessels in the chest
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Expectations (prognosis):
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A complete recovery is usually seen in those with a mild myocardial contusion.
Serious heart injuries can increase your risk for heart failure or heart rhythm disturbances.
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Prevention:
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The following safety tips may help prevent a heart bruise:
- Wear a seat belt when driving
- Choose a car with air bags
- Take appropriate safety precautions when working at heights
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References:
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Hamilton RS. Myocardial contusion. In: Rosen P, Barkin RM, Hayden Sr, Schaider JJ, Wolfe R, eds. Rosen and Barkin's 5-Minute Emergency Medicine Consult. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2007.
Eckstein M, Henderson SO. Thoracic Trauma. In: Marx, JA, ed. Rosen’s Emergency Medicine. 7th ed. Saint Louis, Mo: Mosby Elsevier: 2009: chap 42.
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