Heart injury: classification, mechanisms and diagnostic problems in chest trauma patients (literature review with the results of own observations)


  • S.V. Kursov Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
  • A.V. Beletskyi Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
  • V.V. Nikonov Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
  • Ye.I. Kinoshenko Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine




chest trauma, heart trauma, myocardial contusion, electrocardiographic monitoring, echocardiography, cardiac troponins, review


The literature review presents current ideas about the basic causes and mechanisms of myocardial contusion formation in the patients with trauma, the classification of the severity of traumatic myocardial damage and the basic methods of diagnosis, the results of comparison with the guidelines of the Eastern Association for the surgery of trauma. At the present day, the most acceptable and informative tests for the diagnosis of myocardial contusion in patients with trauma is electrocardiographic monitoring, in combination with the determination of cardiac troponins concentration in the blood. Based on the analysis of the results of the most highly-regarded modern research and our own clinical experience, it has been shown that in any suspicion of myocardial contusion in domestic medical institutions all available diagnostic measures should be used. In all doubtful situations, further diagnostic and therapeutic tactics should be performed only for the be­nefit of a patient.


Download data is not yet available.


Hanschen M, Kanz KG, Kirchhoff Ch, Khalil PN, Wierer M, van Griensven M, Laugwitz KL, Biberthaler P,Lefering R, Huber-Wagner S. Blunt Cardiac Injury in the Severely Injured –A Retrospective Multicentre Study [Internet] PLOS One. [Published: July 2, 2015; cited: June 28, 2018]; 2015:10(7). – Available from: DOI:10.1371/journal.pone.0131362

Stadnik SM. Kliniko-diagnostichni aspekti travmatichnih ushkodzhen sertsya: poglyad kardiologa [Internet];Zdorov’yaUkrayini. 2015: Tematichniy nomer «Kardiologiya, Revmatologiya, Kardiohirurgiya» [published Jan 14, 2016; cited Jun 26, 2018]; 2015:5(42). – Available from: http://health-ua.com/article/4972-klnkodagnostichn-aspekti-travmatichnih-ushkodzhen-sertcya-poglyad-kardologa [Ukrainian]

TraumaRegister DGU. 20 Years TraumaRegister DGU: Development, Aims and Structure: Injury-International Journal of the Care of the Injured.2014 45S:S6-S13. –Available from: http://www.traumaregister-dgu.de/fileadmin/user_upload/traumaregister-dgu.de/docs/Publikation/Artikel_nicht_Publiste/2014_TraumaRegister_-_20_Jahre_-_Entwicklung_u_Ziele.pdf

Moore EE, Malangoni MA, Cogbill TH, Shackford SR, Champion HR, Jurkovich GJ et al. Organ injury scaling IV: Thoracic vascular, lung, cardiac, and diaphragm. Journal of Trauma-Injury, Infection and Critical Care: 1994. Jan 1 36(3):299-300.‑Available from, DOI: 10.1097/00005373-199403000-00002

RuDusky BM. Forensik Cardiovascular Medicine. Boca Raton-London-New York: CRC Press, Taylor & Francis Group; 2009. 210p. – Available from: https://books.google.com.ua/books?id=6PyinHGw00YC&pg=PA186&lpg=PA186&dq=RuDusky+Classification+of+myocardial+contusion&source

RuDusky BM. Classification of Myocardial Contusion and Blunt Cardiac Trauma. Angiology. 2007. 58(5):610-3.– DOI: 10.1177/0003319707305687

Parmley LF, Manion WC, Mattingly TW. Nonpenetrating Traumatic Injury of the Heart. Circulation 1958; Sep 01; 18(3):371-96. – doi: 10.1161/01.CIR.18.3.371

Dermengiu D, Ceausu M, Rusu M, Capatina C, Hostiuc S, Curca GC. Medical Legal Implications of Cardiac Contusion – Case Report. Romanian Journal of Legal Medicine: 2010. 18(2):82-94. – Available from: https://pdfs.semanticscholar.org/6d5e/fd0bf5ebcd3922ad6f64f843e99da9bae2bc.pdf

9.Alborzi Z, Zangouri V, Paydar S, Ghahramani Z, Shafa M, Ziaeian B, Radpey MR, Amirian A, Khodaei S. Diagnosing Myocardial Contusion after Blunt Chest Trauma. Journal of Tehran Heart Center.2016 Apr 13; 11(1):45-54. – Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027160/

Sybrandy KC, Cramer MJ, Burgersdijk C. Diagnosing Cardiac Contusion: Old Wisdom and New Insights. Heart 2003; May; 89(5):485-9. – Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1767619/

Skinner DL, Laing JL, Rodseth RN, Ryan L, Hardcastle TC, Muckart DJJ. Blunt Cardiac Injury in Critically Ill Trauma Patients: a Single Center Experience. Injury: 2015; Jan; 46(1):66-70. – doi: 10.1016/j.injury.2014.08.051

Tan J, Thiagarajan S, Schultz C, Sudhakar R, Hillis G, Marangou J. Assessment of Cardiac Contusion in Motor Vehicle Accident Patients: Heart, Lung & Circulation. 2017; 26(Suppl.2):102-3. – DOI: https://doi.org/10.1016/j.hlc.2017.06.137

Bianco M, Colella F, Pannozzo A, Oradei A, Bucari S, Palmieri V, Zuppi C, Zeppilli P. Boxing and «CommotioCordis»: ECG and Humoral Study: International Journal of Sports Medicine. 2005; Mar; 26(2):151-7.

Bellotti P, Chiarella F, Domenicucci S, Lupi G, Vecchio C. Myocardial Contusion after a Professional Boxing Match: The American Journal of Cardiology. 1992; Mar 01; 69(6):709-10. – Available from: https://doi.org/10.1016/0002-9149(92)90175-X

Krexi L, Shepard MN. Blow/Trauma to the Chest and Sudden Cardiac Death: CommotioCordis and ContusioCordis Are Leading Causes. Medicine, Science and the Law: 2018. Jan 23; 58(2):93-6. – Available from: http://journals.sagepub.com/doi/abs/10.1177/0025802418754961

Vago H, Toth A, Apor A, Maurovich-Horvat P, Toth M, Merkely B. Cardiac Contusion in a Professional Soccer Player. Visualization of Acute and Late Pathological Changes in the Myocardium with Magnetic Resonance Imaging. Circulation. 2010; Jun 8; 121(22):2456-61. – Available from: https://doi.org/10.1161/CIRCULATIONAHA.109.917724

Deady B, Innes G. Sudden Death of a Young Hockey Player: Case Report of CommotioCordis. Journal of Emergency Medicine. 1999; May; 17(3):459-62. – DOI: 10.1016/S0736-4679(99)00006-2

Montgomery JA, Roden DM. CommotioCordis Due to High-Velocity Projectile Ejected from an Industrial Lawnmower. Heart Rhythm Case Reports: 2015; Jul; 1(4):172-5. – Available from: https://www.heartrhythmcasereports.com/article/S2214-0271(15)00020-2/pdf

Kalin J, Madias C, Alsheikh-Ali AA, Link MS. Reduced Diameter Spheres Increases the Risk of Chest Blow-Induced Ventricular Fibrillation (CommotioCordis). Heart Rhythm: 2011 Oct 8(10):1578-81. – Doi: 10.1016/j.hrthm.2011.05.009

Maron BJ, Boren SD, Mark Estes III NA. Early Descriptions of Sudden Cardiac Death Due to CommotioCordis Occurring in Baseball. Heart Rhythm: 2010 Jul 7(7):992-3. – DOI: https://doi.org/10.1016/j.hrthm.2010.04.029

Link MS. CommotioCordis: Ventricular Fibrillation Triggered by Chest Impact–Induced Abnormalities in Repolarization. Circulation: Arrhythmia and Electrophysiology. 2012. Apr 5(2):425-32. – Available from: https://doi.org/10.1161/CIRCEP.111.962712

Link MS, Maron BJ, Wang PJ, Vander Brink BA, Zhu W, Estes NA 3rd. Upper and Lower Limits of Vulnerability to Sudden Arrhythmic Death with Chest-Wall Impact (CommotioCordis). Journal of the American College of Cardiology. 2003; Jan 01; 41(1):99-104. – Available from: https://www.ncbi.nlm.nih.gov/pubmed/12570951?dopt=Abstract

Li W, Zhang L, Liang Ye, Tong F, Zhou Yi. Sudden Death Due to the Atrioventricular Node Contusion: Three Cases Report. Medicine. 2017; Jan; 96(1):e5688. – Doi: 10.1097/MD.0000000000005688

Heberer G Jauch KW, Sabiston DC, Stiegler H, van Dongen RJAM. Vascular Surgery. – Berlin: Springer, Berlin, 2013, 811 p. – Available from: https://books.google.com.ua/books?id=oA7pCAAAQBAJ&pg=PR6&lpg=PR6&dq=Jauch+and+Heberer&source

Özkurtul O, Höcha A, Reske A, Hädrich C, JostenCh, Böhme J. Severe Cardiac Trauma or Myocardial Ischemia? Pitfalls of Polytrauma Treatment in Patients with ST-elevation after Blunt Chest Trauma. Annals of Medicine and Surgery. 2015; Sep; 4(3):254-9. – Available from: https://doi.org/10.1016/j.amsu.2015.07.019

Zhiglyavskaya OA, Borisova OA, Polovinko AE, Pariyskaya TV. Neotlozhnyiesostoyaniya u detey. Noveyshiyspravochnik: Instrumentalnyiemetodyiobsledovaniya [Internet]; Bibliotekaelektronnoyliteraturyi v formate fb2 [2014; cited 18 Jul 2018] – Available from: http://litresp.ru/chitat/ru/%D0%96/zhiglyavskaya-oljga-aleksandrovna/neotlozhnie-sostoyaniya-u-detej-novejshij-spravochnik/6 [Russian]

Yousef R, Carr JA. Blunt Cardiac Trauma: A Review of the Current Knowledge and Management. Annals of Thoracic Surgery. 2014; Sep; 98(3):1134-40. – Available from: https://www.annalsthoracicsurgery.org/article/S0003-4975(14)00828-5/fulltext

Eiferman D, Cotterman RN, Firstenberg MS. Cardiac Trauma; chapter 13 in Principles and Practice of Cardiothoracic Surgery; edited by Firstenberg MS. – London, United Kingdom: INTECH, 2013, p.339-53. – Available from: http://dx.doi.org/10.5772/55723

Gonin J, De La Grandmaison GL, Durigon M, Paraire F. Cardiac Contusion and Hemopericardium in the Absence of External Thoracic Trauma: Case Report and Review of the Literature. American Journal of Forensic Medicine and Pathology. 2009; Dec; 30(4):373-5. – DOI: 10.1097/PAF.0b013e318187e03e

30.Moore K. Contusion of Heart (Myocardial Contusion) [Internet] / HealthLine: Medically reviewed by Gerhard Whitworth, RN on February 23, 2018 [cited 20 Aug 2018] – Available from: https://www.healthline.com/health/myocardial-contusion

Petrovskiy BV, Solovyev GM, Shumakov VI. Protezirovanieklapanovserdtsa. – Moskva: Meditsina, 1966, 231s [Russian]

Analizchetyirehpolnyihtablits s ispolzovaniemneparametricheskihstatisticheskihkriteriev (onlaynkalkulyator) [Internet]; Meditsinskayastatistika: saytdlyaaspirantovimolodyihuchyonyih, vrachey-spetsialistoviorganizatorov, studentoviprepodavateley [2013; cited 24 Aug 2018] – Available from: http://medstatistic.ru/calculators/calchi.html [Russian]

Clancy K, Velopulos C, Bilaniuk J, Collier B, Crowley W, Kurek S, Lui F, Nayduch D, Sangosanya A, Tucker B, Haut ER. Screening for Blunt Cardiac Injury: an Eastern Association for the Surgery of Trauma Practice Management Guideline. Journal of Trauma and Acute Care Surgery. 2012; Nov; 73(5):Suppl.4:S.301-6. – Available from: https://www.east.org/education/practice-management-guidelines/blunt-cardiac-injury%2C-screening-for

Brewer B, Zarzaur BL. Cardiac Contusions. Current Trauma Reports. 2015; Dec; 1(4):232-6. – Available from: https://link.springer.com/article/10.1007/s40719-015-0031-x

Press GM, Miller S. Utility of the Cardiac Component of Fast in Blunt Trauma. Journal of Emergency Medicine. 2013. 44(1): 9-16. – Available from: https://www.jem-journal.com/article/S0736-4679(12)00431-3/pdf

Ferrada P, Vanguri P, Anand RJ, Whelan J, Duane T, Aboutanos M, Malhotra A, Ivatury R. A, B, C, D, Echo: Limited Transthoracic Echocardiogram Is a Useful Tool to Guide Therapy for Hypotension in the Trauma Bay-a Pilot Study. Journal of Trauma & Acute Care Surgery. 2013; Jan; 74(1):220-3. – Doi: 10.1097/TA.0b013e318278918a

Baxi AJ, Restrepo C, Mumbower A, McCarthy M, Rashmi K. Cardiac Injuries: A Review of Multidetector Computed Tomography Findings. Trauma Monthly. 2015; Nov 23; 20(4):e19086. –Doi: 10.5812/traumamon.19086

Berezin AE. Serdechnyietroponinyikakmarkeryityazhestimiokardialnoydisfunktsiiineblagopriyatnogoprognoza u patsientov s serdechnoynedostatochnostyu (obzorliteraturyi). Ukrayinskiymedichniychasopis. 2013:(4):102-9. – Available from: http://nbuv.gov.ua/UJRN/UMCh_2013_4_24 [Russian]

Garg P, Morris P, Fazlanie AL, Vijayan S, Dancso B, Dastidar AG, Plein S, Mueller C, Haaf P. Cardiac Biomarkers of Acute Coronary Syndrome: from History to High-Sensitivity Cardiac Troponin. Internal&EmergencyMedicine. 2017; Mar; 12(2):147-55. Doi: 10.1007/s11739-017-1612-1

Swaanenburg JCJM, Klaase JM, De Jongste MJL, Zimmerman KW, Jan ten Duis  H. Troponin I, Troponin T, CKMB-Activity and CKMB-Mass as Markers for the Detection of Myocardial Contusion in Patients Who Experienced Blunt Trauma. ClinicaChimicaActa. 1998:272:171-81. – Available from: https://pdfs.semanticscholar.org/b0c8/3d611a724c1ac6e5d169b2a38d8901fb6836.pdf

Akwe J, Hakford B, Kim E, Miller A. A Review of Cardiac and Non-Cardiac Causes of Troponin Elevation and Clinical Relevance. Part I: Cardiac Causes. Journal of Cardiology & Current Research. 2017; Dec 28; 10(3):e00360. – Available from: http://medcraveonline.com/JCCR/JCCR-10-00360.pdf

Joseph B, Jokar TO, Khalil M, Haider AA, Kulvatunyou N, Zangbar B, Tang A, Zeeshan M, O'Keeffe T, Abbas D, Latifi R, Rhee P. Identifying the Broken Heart: Predictors of Mortality and Morbidity in Suspected Blunt Cardiac Injury. American Journal of Surgery. 2016; Jun; 211(6):982-8. –Doi: 10.1016/j.amjsurg.2015.10.027

Velmahos GC, Karaiskakis M, Salim A, Toutouzas KG, Murray J, Asensio J, Demetriades D. Normal Electrocardiography and Serum Troponin I Levels Preclude the Presence of Clinically Significant Blunt Cardiac Injury. Journal of Trauma. 2003; Jan; 54(1):45-50. – Doi: 10.1097/01.TA.0000046315.73441.D8

Bertinchant JP, Polge A, Mohty D, Nguyen-Ngoc-Lam R, Estorc J, Cohendy R, Joubert P, Poupard P, Fabbro-Peray P, Monpeyroux F, Poirey S, Ledermann B, Raczka F, Brunet J, Nigond J, de la Coussaye JE. Evaluation of Incidence, Clinical Significance, and Prognostic Value of Circulating Cardiac Troponin I and T Elevation in Hemodynamically Stable Patients with Suspected Myocardial Contusion after Blunt Chest Trauma. Journal of Trauma. 2000; May; 48(5):924-31. – Available from: https://www.ncbi.nlm.nih.gov/pubmed/10823538

Rajan GP, Zellweger R. Cardiac Troponin I as a Predictor of Arrhythmia and Ventricular Dysfunction in Trauma Patients with Myocardial Contusion. Journal of Trauma. 2004; Oct; 57(4):801-8. – Available from: https://www.ncbi.nlm.nih.gov/pubmed/15514534



How to Cite

Kursov, S., Beletskyi, A., Nikonov, V., & Kinoshenko, Y. (2021). Heart injury: classification, mechanisms and diagnostic problems in chest trauma patients (literature review with the results of own observations). EMERGENCY MEDICINE, (8.95), 7–18. https://doi.org/10.22141/2224-0586.8.95.2018.155150



Scientific Review

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>