Penetrating cardiac injuries often lead to immediate cardiovascular collapse, and patients rarely survive to reach the operating room. Injuries associated with penetrating cardiac trauma include pericardial tamponade, cardiac perforation, rupture of a chamber, and fistula formation.

Blunt cardiac injuries (BCI) include cardiac contusion (most common), pericardial rupture, rupture of a chamber, valvular tears, coronary artery injuries, and ventricular aneurysms. Screening for BCI includes an electrocardiogram (ECG) and troponin I level; echocardiography is reserved for those with new ECG changes, elevated troponin I levels, hypotension, and/or arrhythmias. At the very least, patients with abnormal cardiac studies should be admitted for monitoring.

References

• Bellister SA, Dennis BM, Guillamondegui OD. Blunt and penetrating cardiac trauma. Surg Clin North Am. 2017;97:1065-1076.
• Clancy K, Velopulos C, Bilaniuk J, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma. 2012;73:S301-S306.
• Howes BL, Shapiro ML. Thoracic trauma management. In: Barbeito A, Shaw AD, Grichnik K, eds. Thoracic Anesthesia. McGraw-Hill; 2012:379-402.