1. Diagnosing cardiac contusion : old wisdom and new insights
K C Sybrandy, M J M Cramer and C Burgersdijk
20 November 2002
CS Intern 이웅재

2. car or motorcycle accidents
incidence ; 3-56 %

3. Possible complications of cardiac injury
ventricular arrhythmias and cardiac failure (16%)
; It is important to screen all patients with blunt chest trauma to identify risk for complications.

4. CAUSES AND CLINICAL FEATURES
steering wheel or rapid deceleration
; thoracic wall compresses the heart between the sternum and spine
falls from a great height, sport injuries, blast forces, and indirect compression on the abdomen with upward displacement of abdominal viscera

5. Hemodynamic instability
; easily masked in trauma patients due to other severe injuries with blood loss or associated pulmonary, vascular, and neurological injuries.
only mild symptoms, such as palpitations or precordial pain

6. Chest radiography and thoracic computed tomography
Magnetic resonance imaging

7. BIOCHEMICAL CARDIAC MARKERS
First screening tool
Histologicaly ; intramyocardial hemorrhage, edema, and necrosis of myocardial muscle cells
Creatine kinase (CK)
CK-MB
troponin I and troponin T (myocardial regulatory contractile proteins)
; measurment after 4-6 hours / persist for 4-6 days

8. Electrocardiographic findings
The ECG after blunt chest trauma
; normal or non-specific abnormalities
right ventricle > left ventricle

10. ECHOCARDIOGRAPHY
functionally

12. RADIONUCLIDE IMAGING Ventriculography
Myocardial perfusion scintigraphy
Positron emission tomography

13. IDENTIFICATION OF PATIENTS AT RISK
troponin I and troponin T
; very helpful in the stratification of patients at risk for complications.

15. Screening strategy

16. TREATMENT Cardiac monitoring
; Complication - within hours after the trauma.

17. CONCLUSION
Diagnosing a cardiac contusion remains a significant challenge.
cardiospecific troponin I and troponin T assays
; much easier to detect myocardial injury
/ risk for life threatening complications.
combination with an ECG
; sufficient for identifying the vast majority of patients who were at risk

18. Moreover, patients with normal troponin I or T concentrations and ECG can be safely sent home.