Cardiac contusion is an uncommon condition that is too-commonly worried about. It requires extreme blunt force with a significant head-on component. The most common mechanisms are car crashes (steering wheel) and sports injuries.

A true cardiac contusion is very rare. If a patient did not strike their chest hard enough to cause significant and lasting anterior chest pain, they probably do not have one. If the force was enough to cause a sternal fracture, there is some possibility they may have sustained a cardiac contusion. During ED evaluation, if a patient with a significant mechanism does not exhibit any arrhythmias, they do not have a contusion.

Diagnosis is relatively simple: any trauma patient with a likely mechanism who has chest wall pain and a new arrhythmia or cardiac pump failure has a cardiac contusion. Atrial or ventricular arrhythmias are significant, but a ventricular one is significant because it can degenerate into v-tach or worse.Enzyme measurements do not indicate severity of injury or outcome and should not be obtained.

From a nursing standpoint, you should monitor for and report the following:

• A new arrhythmia, especially a ventricular one. Medications or cardioversion may be ordered to treat.
• Hypotension, pulmonary congestion, or other signs or heart failure. An echocardiogram or vasoactive medications may be ordered.

Remember, true cardiac contusion is rare! If suspected, telemetry is indicated, along with frequent vital signs. Cardiac enzymes should not be ordered, and any indication of cardiac problems (arrhythmia or failure) should be reported and treated promptly.