Injury of the Heart and Great Vessels

There are two general types of injuries of the heart, namely, contusions and wounds. Contusion of the heart results from blunt trauma, and this is probably the most frequent type of injury, as well as the most frequently overlooked. The pathology may vary from petechiae to areas of massive hemorrhage. Myocardial ischemia may result from direct injuries to coronary arteries or compression and obliteration of the lumen by edema from myocardial injury. Myocardial irritability is increased. The injury or complications therefrom are similar to a myocardial infarction, and myocardial insufficiency may ensue. Treatment should be that of myocardial infarction; however, the diagnosis has to be suspected before treatment can be considered. Blunt trauma to the chest, typically the steering-wheel injuries, or chest wounds from high-velocity missiles, should lead one to suspect heart contusion, especially if findings are out of proportion to the apparent injury, and if the patient shows a