Cardiac injury after chest trauma

Fifty consecutive patients with severe chest trauma were studied prospectively to evaluate the frequency of significant cardiac injury and to determine what diagnostic studies were useful. Forty-nine of 50 patients had elevated cardiac enzymes and 26 of 50 had abnormal ECGs on admission. No patient had complications associated with myocardial infarction, including 15 who underwent general anesthesia. We found persistent (greater than 48 h) ECG changes in only 3, 2 of these 3 also had markedly elevated MB fraction of CPK. Significant pericarditis occurred in 5 patients, 2 of whom never had ECG abnormalities. We conclude that minor cardiac injury is common in severe chest trauma, but only rarely causes myocardial contusion. Myocardial isoenzymes may be useful in making that important distinction. Clinically significant traumatic pericarditis may occur in the absence of ECG changes and must be considered in every patient with chest injury and unstable hemodynamics.