Authors
Chanakhchian F.N.1, Alekhnovich A.V.1, Vakhromeeva M.N.2, Denisenko-Kankiya E.I.3, Akhiev M.I.1, Rumyantseva A.M.1
1 National Medical Research Center of high medical technologies – the Vishnevsky Central Military Clinical Hospital, Krasnogorsk
2 Pirogov National Medical and Surgical Center, Moscow
3 Hospital for War Veterans №3, Moscow
Abstract
Trauma remains a leading global cause of mortality, particularly in the young population. Cardiac damage is a predictor for poor outcome after multiple traumas, with a poor prognosis and prolonged in-hospitalization. Cardiac injury encompasses a spectrum of pathologies ranging from clinically silent, transient arrhythmias to deadly cardiac wall rupture. Of diagnosed cardiac injuries cardiac contusion (blunt cardiac injury) and commotio cordis are most common. Timely diagnosis of this category of victims is a key aspect of successful treatment and emergency care both at the pre-hospital stage and in a specialized medical institution. This narrative review focuses on the main types, etiopathology, as well as classification of cardiac trauma. It explains the main histopathological difference between blunt cardiac injury and myocardial infarction.
Keywords: cardiac trauma, cardiac contusion, blunt cardiac injury, penetrating injury, commotio cordis, myocardial infarction, cardiac rupture.
References
1. Roshanaei G, Khoshravesh S, Abdolmaleki S, et al. Epidemiological pattern of trauma patients based on the mechanisms of trauma: trends of a regional trauma center in Midwest of Iran. BMC Emerg Med. 2022; 210 (22). doi: 10.1186/s12873-022-00756-9.
2. National Trauma Institute. Source CDC. [URL].
3. Shaimardanov RSh, Gubaev RF, Korobkov BN, Filippov VA. Diagnostics and surgical tactics at wounds of heart. The Bulletin of Contemporary Clinical Medicine. 2014; 7(2): 205-208 (In Russ.) doi: 10.20969/VSKM.2014.7 (suppl.2).1-232.
4. Dzhanelidze YuYu. Rany` serdcza i ix xirurgicheskoe lechenie. Leningrad. Leningrad med.j. 1927. 336 p. (In Russ.)
5. Zheltovskij YuV, Podkamenny`j VA, Vereshhagin VA. Injuries of the heart and pericardium in thoraco-abdominal wounds. Vestn Khir Im. 1985; 134(3): 79-82. (In Russ.)
6. Apostolakis E, Apostolaki G, Apostolaki M, et al. The reported thoracic injuries in Homer’s Iliad. J Cardiothorac Surg. 2010; 5: 114. doi: 10.1186/ 1749-8090-5-114.
7. Hromalik LR Jr, Wall MJ Jr, Mattox KL, Tsai PI. Penetrating cardiac injury: a narrative review. Mediastinum. 2023; 7: 15. doi: 10.21037/med-22-18.
8. Pereira BMT, Nogueira VB, Calderan TRA, et al. Penetrating cardiac trauma: 20-y experience from a university teaching hospital. Journal of Surgical Research. 2013; 183(2): 792-797. doi: 10.1016/j.jss.2013.02.015.
9. Basarab DA, Ustyuzhin ED, Perutskiy DN, Basarab AI. Penetration cardiac wound associated with anterior mitral leaflet perforation: a case report and review of the literature. Almanac of clinical medicine. 2019; 47(4): 361-369 (In Russ.) doi: 10.18786/2072-0505- 2019-47-038.
10. Topolnitskiy EB, Sivolap MP. Analysis of heart injury and mortality in victims with heart wounds in peacetime in the civilian setting. Bulletin of the East Siberian Scientific Center SBRAMS. 2007; 1(53): 199-200. (In Russ.)
11. Smirnov E, Girgolav S, Orbeli L. Opyt sovetskoj mediciny v Velikoj Otechestvennoj vojne 1941-1945. V 35 tomakh. Tom 9. Raneniya grudi. M.: Gosudarstvennoe izdatel’stvo medicinskoj literatury, 1952-1955. 564 p. (In Russ.)
12. Degiannis E, Bowley DM, Westaby S. Penetrating cardiac injury. Ann R Coll Surg Engl. 2005; 87(1): 61-3. doi: 10.1308/1478708051207.
13. Asensio JA, Murray J, Demetriades D, et al. Penetrating cardiac injuries: a prospective study of variables predicting outcomes. J Am Coll Surg. 1998; 186(1): 24-34. doi: 10.1016/s1072-7515(97)00144-0.
14. Rosstar L. Boevy`e ognestrel`ny`e raneniya v serdce. Krovenosny`e sosudy` [Combat gunshot heart wound 2. Vessels.]. Tartu: TU EE2400, 1993. 132 p. (In Russ.)
15. Warburg E. Myocardial and pericardial lesions due to non-penetrating injury. Br Heart J. 1940; 2(4): 271-80. doi: 10.1136/hrt.2.4.271.
16. Denisov AV, Kuzmin AYa, Gavrilin SV, et al. Heart contusion in case of closed chest injuries: etiology, diagnosis, severity of heart damage (literature review). Russian military medical journal. 2018; 339(8): 24-32. (In Russ.) doi: 10.17816/RMMJ73014.
17. RuDusky BM. Classification of myocardial contusion and blunt cardiac trauma. Angiology. 2007; 58(5): 610-613. doi: 10.1177/0003319707305687.
18. Yousef R, Carr JA. Blunt cardiac trauma: a review of the current knowledge and management. Ann Thorac Surg. 2014; 98(3): 1134-40. doi: 10.1016/j.athoracsur.2014.04.043.
19. Sokolova LA, Gorlova IA, Omelchenko MYu, Bondarenko BB. Commotio cordis as cause of sudden cardiac death associated with chest trauma. Translyatsionnaya meditsina. 2022; 9(1): 5-11. (In Russ.) doi: 10.18705/2311-449-2022-9-1-5-11.
20. Link MS. Commotio cordis: ventricular fibrillation triggered by chest impact-induced abnormalities in repolarization. Circ Arrhythm Electrophysiol. 2012; 5(2): 425-32. doi: 10.1161/CIRCEP.111.962712.
21. El-Andari R, O’Brien D, Bozso SJ, Nagendran J. Blunt cardiac trauma: a narrative review. Mediastinum. 2021; 5: 28. doi: 10.21037/med-21-19.
22. Fadel R, El-Menyar A, ElKafrawy S, Gad MG. Traumatic blunt cardiac injuries: An updated narrative review. Int J Crit Illn Inj Sci. 2019; 9(3): 113-119. doi: 10.4103/IJCIIS.IJCIIS_29_19.
23. Link MS, Estes NAM. Sudden Cardiac Deaths in Athletes, Including Commotio Cordis. Cardiac Electrophysiology: From Cell to Bedside, 2018: 1020–1031. doi:10.1016/b978-0-323-44733-1.00108-5.
24. Kalin J, Madias C, Alsheikh-Ali AA, Link MS. Reduced diameter spheres increases the risk of chest blow-induced ventricular fibrillation (commotio cordis). Heart Rhythm. 2011; 8(10): 1578-81. doi: 10.1016/j.hrthm. 2011.05.009.
25. Link MS, Wang PJ, Pandian NG, et al. An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis). N Engl J Med. 1998; 338(25): 1805-11. doi: 10.1056/NEJM199806183382504.
26. Maron BJ, Estes NA 3rd. Commotio cordis. N Engl J Med. 2010; 362(10): 917-27. doi: 10.1056/NEJMra0910111.
27. Reiter T, Ritter O, Beer M, Petritsch B. An unusual finding after resuscitation: contusio cordis. Clin Res Cardiol. 2012; 101(9): 767-70. doi: 10.1007/s00392-012-0449-x.
28. Wall Jr MJ, Tsai PI, Mattox KL. Heart and Thoracic Vascular Injuries. In: Moore EE, Feliciano DV, Mattox KL. eds. Trauma, 8e. McGraw Hill; 2017.
29. Sumin A.N. Heart contusion diagnosis and treatment in polytrauma. Polytrauma. 2006. 1: 85-91. (In Russ.)
30. Bansal MK, Maraj S, Chewaproug D, Amanullah A. Myocardial contusion injury: redefining the diagnostic algorithm. Emerg Med J. 2005; 22(7): 465-9. doi: 10.1136/emj.2004.015339.
31. Bock JS, Benitez RM. Blunt Cardiac Injury. Cardiology Clinics. 2012; 30(4): 545-555. doi: 10.1016/j.ccl.2012.07.001.
32. Farrokhian AR. Commotio Cordis and Contusio Cordis: Possible Causes of Trauma-Related Cardiac Death. Arch Trauma Res. 2016; 5(4): e41482. doi: 10.5812/atr.41482.
33. Tenzer ML. The spectrum of myocardial contusion: a review. J Trauma. 1985; 25(7): 620-7. doi: 10.1097/00005373-198507000-00008.
34. Maksimov DA, Boiarinсev VV, Stazhadze LL, et al. Heart injury mechanisms in blunt chest trauma. Pathophysiological features, clinical manifestations and treatment strategy. Kremlin medicine Journal. 2019; 3: 98-108 (In Russ.) doi: 10.26269/y374-nr97/
35. Agarwal D, Chandra S. Challenges in the diagnosis of blunt cardiac injuries. Indian J Surg. 2009; 71(5): 245-53. doi: 10.1007/s12262-009-0078-4.
36. Korpacheva OV. Cardiac Contusion: Unsolved Problems of Theory and Practice. General reanimatology. 2008; 4(6): 76-79. (In Russ.) doi: 10.15360/1813-9779-2008-6-76.
37. Burakovskiy VI, et al. Serdechno-sosudistaya xirurgiya. Moscow: Medicina, 1989. 750p. (In Russ.)
38. Gulyaev NI, Vovkodav VS, Datsko AE, et al. Cardiac trauma. Manual guidelines. – M.: FGFI “NMRC HMT N.A. A.A. Vishnevsky”, 2024. 68p. (In Russ.)
