Myocardial Contusion

What is a myocardial contusion?

A myocardial contusion, or blunt myocardial injury, is bruised heart muscle. This happens when something hits your chest hard but doesn’t go through your skin. Most of the time, a car crash is the cause.

Myocardial contusion, or cardiac contusion, can range from a little bruise that doesn’t cause problems to a more severe injury that makes your heart muscle unable to work well.

Myocardial contusion vs. cardiac tamponade

Both of these conditions have similar symptoms, but they aren’t the same.

A myocardial contusion is a bruise that affects your heart muscle. Cardiac tamponade is a collection of fluid in the sac around your heart. This excess fluid puts pressure on your heart.

A blood test can tell you if you have a bruised heart.

Who does a myocardial contusion affect?

A myocardial contusion can affect anyone. Examples include:

• A teenager or young adult who gets hurt while participating in an extreme sport.
• A middle-aged person who falls while working on a high construction site.
• A person in their 80s who gets a chest injury during a car accident.

How common is a myocardial contusion?

Myocardial contusion happens in up to 10% of people with a sternal fracture. A broken sternum (the vertical bone between your ribs) is rare.

Major blunt trauma to the chest injures the heart in just 15% of cases.

What are the cardiac contusion symptoms?

You may not have symptoms other than a fast heartbeat if your myocardial contusion is mild.

If your myocardial contusion is bad, it may feel like you’re having a heart attack.

Myocardial contusion symptoms may include:

• Shortness of breath.
• Lightheadedness.
• Upset stomach.
• Heart palpitations.
• Pain in your ribs (chest).

What causes a cardiac contusion?

Most of the time, an accident causes cardiac contusion.

Causes include:

• A fall of 20 feet or more.
• Injury while playing sports.
• Car accidents.
• CPR (cardiopulmonary resuscitation).

How is a cardiac contusion diagnosed?

A cardiac contusion diagnosis can be difficult. You can have a bad case of it without obvious signs of trauma on the outside of your chest.

Your healthcare provider will do a physical exam and tests.

If you have a myocardial contusion, they may find:

• Signs of broken ribs, like a crunching feeling on your chest.
• Low blood pressure.
• Abnormal heartbeat.
• Fast breathing.
• Scrapes or bruises on your chest.

What tests will be done to diagnose a myocardial contusion?

Tests for a myocardial contusion may include:

• Chest X-ray.
• Chest CT (computed tomography) scan.
• Echocardiogram.
• Electrocardiogram (EKG).
• Heart MRI.
• Blood test for a cardiac enzyme (troponin I or troponin T) that shows up in your blood after a heart muscle injury.

What is the treatment for a myocardial contusion?

Healthcare providers don’t have a specific treatment plan for a myocardial contusion. However, they’ll watch you closely and treat any complications as they happen.

In the emergency department, you may receive:

• Oxygen.
• Fluids through an IV in your arm or hand.
• Medicine for an abnormal heart rate, low blood pressure or pain.
• A temporary pacemaker.
• A chest tube to drain extra blood around your heart.

If your blood test confirms that you have heart muscle damage, your provider will admit you to the hospital. They’ll keep checking your troponin I level by repeating the blood test at different times.

Complications of a cardiac contusion may include:

• Heart failure.
• Myocardial rupture.
• Cardiac tamponade.
• Cardiogenic shock.
• Abnormal heart rhythms.
• Death without warning.

How long does it take to recover from a myocardial contusion?

It can take weeks or months to recover from a myocardial contusion, depending on your situation and the severity of the injury.

What can’t I eat with this condition?

If you develop heart failure after getting a myocardial contusion, your healthcare provider may ask you to eat foods that are low in salt.

What medications/treatments are used?

Treatments and medicines you may need may be different from one person to another, depending on which complications you have. Your healthcare provider may give you:

• Blood pressure medicines that make it easier for your heart to pump with heart failure.
• Pericardiocentesis to remove extra fluid from your pericardium (sac around your heart) to ease pressure from cardiac tamponade.
• Medicine or a pacemaker for abnormal heart rhythms.
• Medicine or temporary devices to help your heart pump better if you have cardiogenic shock.
• Surgery to repair a myocardial rupture (this is rare).

Complications/side effects of the treatment

Complications and side effects are different from one myocardial contusion treatment to another.

They may include:

• Dizziness or other side effects from heart medicines your healthcare provider may prescribe.
• Infection or bleeding from surgery or a pericardiocentesis.
• Medical devices not working right.

How soon after treatment will I feel better?

Devices that help your heart pump should improve your situation right away. They physically assist with moving blood through your body.

Medicines can start working quickly if you get them through an IV.

How can I prevent a myocardial contusion?

To prevent a myocardial contusion, you need to avoid the accidents that can cause it.

Although you can’t prevent all accidents, you can:

• Drive a car that has airbags.
• Use your seat belt while driving or riding in a vehicle.
• Use safety equipment when working on a tall structure.
• Wear protective gear for your sport.

What can I expect if I have a myocardial contusion?

Your healthcare provider will watch you closely for 24 to 48 hours. They’ll check your heart rhythm with an electrocardiogram (EKG) the entire time.

How long does a myocardial contusion last?

A cardiac contusion rarely causes major issues that last a long time. Abnormal heart rhythms from a myocardial contusion usually go away in 24 hours.

Outlook for a myocardial contusion

Most people with minor injuries and normal heart rhythms don’t develop complications. Usually, people with a mild cardiac contusion make a full recovery. If your contusion is bad, it can make you more likely to get heart failure or an abnormal heart rhythm.

How do I take care of myself?

You’ll need to give your body time to recover from your cardiac contusion. This may mean you can’t take part in your favorite sport for a while. Follow your healthcare provider’s instructions.

When should I see my healthcare provider?

After any visit to the emergency room, you should follow up with your primary healthcare provider. You may be dealing with complications of cardiac contusion afterward instead of the bruised heart itself. You’ll need follow-up appointments with your provider if they’re treating complications of cardiac contusion.

Because some rare complications can happen later, you should see your provider three to six months after your injury.

What questions should I ask my doctor?

• When can I drive or play sports again?
• What can I do to protect myself next time?
• How long will I have complications from this?

A note from Cleveland Clinic

Because accidents happen without warning, they can leave you feeling rattled. You’re in good hands once emergency help arrives. Even if you don’t think you need to stay overnight for observation, it’s best to do it. Your healthcare provider will want to make sure you don’t have serious complications from your accident. After you leave the hospital, be sure to keep all follow-up appointments and continue taking any medicine your provider prescribed for you.