Cardiac Contusion

Cardiac contusion is damage to the myocardium — ranging from edema and hemorrhage to necrosis or rupture — after blunt chest trauma (motor vehicle crash, fall, steering wheel impact, sports injury). The right ventricle is most often affected because it lies closest to the chest wall.

The clinical spectrum is wide: some patients are asymptomatic, whereas others develop serious arrhythmias, heart failure, valve damage or ventricular wall rupture. Commotio cordis is a distinct entity in which a minor chest impact during sports triggers sudden ventricular fibrillation.

Diagnosis is based on the trauma history, ECG, cardiac troponin, echocardiography and, when needed, cardiac MRI. Treatment depends on severity and may include monitoring, arrhythmia management, heart failure therapy and rarely surgical repair.