Cardiac contusion refers to a condition characterized by a bruise or injury to the heart muscle. It typically occurs as a result of a traumatic event, such as a car accident, fall, or forceful blow to the chest. The impact causes damage to the delicate tissues of the heart, leading to symptoms such as chest pain, irregular heartbeat, difficulty breathing, and sometimes, even heart failure. Prompt medical attention and appropriate management play a crucial role in facilitating the healing process.

What are the symptoms of cardiac contusion? 

Mild cardiac contusion may not present noticeable symptoms apart from a rapid heartbeat.

However, severe cardiac contusion can mimic symptoms of a heart attack.

Symptoms of cardiac contusion may include:

  • Shortness of breath
  • Feeling lightheaded
  • Upset stomach
  • Heart palpitations
  • Chest pain in the rib area

What are the different types of cardiac contusion? 

There are three types of contusions: intramuscular contusions, intermuscular contusions, and bone bruises.

  • Intramuscular contusions: these involve tearing of the muscle within its surrounding sheath. The initial bleeding may stop early due to increased pressure within the muscle, but the sheath prevents fluid from escaping. This results in significant loss of function and pain, which can take days or weeks to resolve. Bruising may not be immediately visible, leading to potential underestimation of the injury. Bruising may appear later during the subacute phase, indicating progressive healing.
  • Intermuscular contusions: these involve tearing of the muscle and part of the surrounding sheath. The initial bleeding takes longer to stop compared to intramuscular contusions. However, recovery is relatively quicker as blood and fluids can flow away from the injury site through tears in the muscle sheath. Bruising is a characteristic feature of this type of contusion.
  • Bone contusions: these penetrate into the skeletal structures, resulting in a bone bruise. These bruises are painful and require a relatively longer healing period.


How is cardiac contusion diagnosed? 

Diagnosing a cardiac contusion can be challenging, as external signs of trauma may not be apparent on the chest. Healthcare providers rely on physical examinations and tests to make a diagnosis.

Physical examination for a myocardial contusion may reveal:

  • Signs of broken ribs, such as a crunching feeling in the chest
  • Low blood pressure
  • Abnormal heartbeat
  • Rapid breathing
  • Scrapes or bruises on the chest

Diagnostic tests for myocardial contusion may include:

  • Chest X-ray
  • Chest CT (computed tomography) scan
  • Echocardiogram
  • Electrocardiogram (EKG)
  • Heart MRI
  • Blood test to detect cardiac enzymes (troponin I or troponin T) that indicate heart muscle injury

How is cardiac contusion treated?

The treatment approach for a cardiac contusion is not standardized, but healthcare providers closely monitor patients and address any complications as they arise.

In the emergency department, initial treatment may include:

  • Administration of oxygen
  • Intravenous fluids
  • Medications to manage abnormal heart rate, low blood pressure, or pain
  • Placement of a temporary pacemaker
  • Insertion of a chest tube to drain excess blood around the heart

Potential complications of cardiac contusion include:

  • Heart failure
  • Myocardial rupture
  • Cardiac tamponade
  • Cardiogenic shock
  • Irregular heart rhythms
  • Sudden unexpected death