Clinical Assessment and Management of Blunt Cardiac Injury for Nursing and Frontline Healthcare Providers
Abstract
Background: Blunt cardiac injury (BCI) encompasses a spectrum of conditions resulting from chest trauma. While most patients, particularly those with minor injuries, recover fully, a subset with severe trauma faces significant acute and delayed complications. The diagnosis and management of BCI are challenging due to its variable presentation and the lack of universal diagnostic criteria.
Aim: This article aims to review the potential complications, long-term management strategies, and the critical role of interprofessional collaboration in optimizing outcomes for patients with BCI.
Methods: The approach is based on a review of clinical practices and consensus. It advocates for a systematic management protocol involving initial screening with electrocardiography (ECG) and troponin levels, inpatient monitoring for high-risk patients, and structured medium-term follow-up.
Results: Most patients with minor BCI recover without lasting consequences. However, severe injuries can lead to acute complications (e.g., chamber rupture) or delayed sequelae such as heart failure, arrhythmias, pericardial effusion, and constrictive pericarditis. Effective management hinges on a coordinated, interprofessional team approach, clear patient education on warning symptoms, and a recommended follow-up evaluation at 3 to 6 months post-injury.
Conclusion: A proactive and collaborative approach, balancing the generally favorable prognosis with vigilance for rare but serious complications, is essential for the effective long-term care of patients with BCI.
Full text article
References
Biffl WL, Fawley JA, Mohan RC. Diagnosis and management of blunt cardiac injury: What you need to know. J Trauma Acute Care Surg. 2024 May 01;96(5):685-693.
Elie MC. Blunt cardiac injury. Mt Sinai J Med. 2006 Mar;73(2):542-52.
Hammer MM, Raptis DA, Cummings KW, Mellnick VM, Bhalla S, Schuerer DJ, Raptis CA. Imaging in blunt cardiac injury: Computed tomographic findings in cardiac contusion and associated injuries. Injury. 2016 May;47(5):1025-30.
Marcolini EG, Keegan J. Blunt Cardiac Injury. Emerg Med Clin North Am. 2015 Aug;33(3):519-27.
Mattox KL, Flint LM, Carrico CJ, Grover F, Meredith J, Morris J, Rice C, Richardson D, Rodriquez A, Trunkey DD. Blunt cardiac injury. J Trauma. 1992 Nov;33(5):649-50.
Savoia P, Jayanthi SK, Chammas MC. Focused Assessment with Sonography for Trauma (FAST). J Med Ultrasound. 2023 Apr-Jun;31(2):101-106.
Skinner DL, Laing GL, Rodseth RN, Ryan L, Hardcastle TC, Muckart DJ. Blunt cardiac injury in critically ill trauma patients: a single centre experience. Injury. 2015 Jan;46(1):66-70.
Huis In 't Veld MA, Craft CA, Hood RE. Blunt Cardiac Trauma Review. Cardiol Clin. 2018 Feb;36(1):183-191.
Yousef R, Carr JA. Blunt cardiac trauma: a review of the current knowledge and management. Ann Thorac Surg. 2014 Sep;98(3):1134-40.
Leite L, Gonçalves L, Nuno Vieira D. Cardiac injuries caused by trauma: Review and case reports. J Forensic Leg Med. 2017 Nov;52:30-34.
Kalbitz M, Pressmar J, Stecher J, Weber B, Weiss M, Schwarz S, Miltner E, Gebhard F, Huber-Lang M. The Role of Troponin in Blunt Cardiac Injury After Multiple Trauma in Humans. World J Surg. 2017 Jan;41(1):162-169.
Salim A, Velmahos GC, Jindal A, Chan L, Vassiliu P, Belzberg H, Asensio J, Demetriades D. Clinically significant blunt cardiac trauma: role of serum troponin levels combined with electrocardiographic findings. J Trauma. 2001 Feb;50(2):237-43.
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. J Trauma. 2003 Jan;54(1):45-50; discussion 50-1.
Martin M, Mullenix P, Rhee P, Belzberg H, Demetriades D, Salim A. Troponin increases in the critically injured patient: mechanical trauma or physiologic stress? J Trauma. 2005 Nov;59(5):1086-91.
Nair L, Winkle B, Senanayake E. Managing blunt cardiac injury. J Cardiothorac Surg. 2023 Feb 10;18(1):71.
Schultz JM, Trunkey DD. Blunt cardiac injury. Crit Care Clin. 2004 Jan;20(1):57-70.
Sybrandy KC, Cramer MJ, Burgersdijk C. Diagnosing cardiac contusion: old wisdom and new insights. Heart. 2003 May;89(5):485-9.
Kyriazidis IP, Jakob DA, Vargas JAH, Franco OH, Degiannis E, Dorn P, Pouwels S, Patel B, Johnson I, Houdlen CJ, Whiteley GS, Head M, Lala A, Mumtaz H, Soler JA, Mellor K, Rawaf D, Ahmed AR, Ahmad SJS, Exadaktylos A. Accuracy of diagnostic tests in cardiac injury after blunt chest trauma: a systematic review and meta-analysis. World J Emerg Surg. 2023 May 27;18(1):36.
Authors
Copyright (c) 2025 Ali Ismail Gaisi, Farih Bustan Al-Ruwaili, Saad Sanaitan Al-Mutairi, Turki Ghazi Turki Al-Otaibi, Ayat Adnan Al-Bahrani, Zainab Matoog Al-Jadin, Amal Mattoq Al-Jaidan, Abduladeem Radi Al-Jubaili, Bader Mohammed Al-Mohasen, Zahra Hassan Al-Asmari, Reem Hilal Break Al-Otaibi, Abdulaziz Khalif Al-Mutairi
This work is licensed under a Creative Commons Attribution 4.0 International License.