COLLISION CARDIOMYOPATHY: BLUNT CARDIAC INJURY IN THE SETTING OF A MOTOR VEHICLE ACCIDENT

Document Type

Conference Proceeding

Publication Date

4-1-2024

Publication Title

J Am Coll Cardiol

Abstract

Background Blunt cardiac injury (BCI) encompasses a spectrum of myocardial disease secondary to blunt thoracic trauma (BTT). Patients develop arrhythmias, valvular injury, chamber rupture, and myocardial infarction. BCI can be asymptomatic or present as chest pain, dyspnea, or sudden death. Electrocardiogram is the most sensitive initial testing modality for BCI. Abnormal findings include ectopic beats, conduction defects, atrial fibrillation, and ventricular fibrillation. Further testing including cardiac biomarkers and echocardiography are recommended in patients with an abnormal initial workup. Case A 62-year-old man with hypertension presented after being struck by a vehicle while riding his bicycle. Prior to this, he performed a labor-intensive job and had no symptoms. During the accident, he was ejected off his bicycle causing him to land on the ground with impact to his anterior chest. Trauma evaluation for injuries was notable for lumbar midline and paraspinal back tenderness without other overt signs of trauma. Imaging revealed an acute lumbar spine fracture that did not require surgical intervention. EKG showed a NSR with frequent ectopic ventricular beats; telemetry monitoring revealed a high ectopic burden. Cardiac biomarkers were abnormal with a hsTnI peak of 28 ng/L and high BNP of 178 pg/mL. Echocardiogram was significant for an LV EF of 40%. Decision-making Our patient was found to have cardiac dysfunction in the setting of BTT without overt signs or symptoms of heart failure. His constellation of ventricular ectopy and a reduced LV EF were concerning for BCI. Ischemic evaluation with a Coronary CTA showed minimal non-obstructive CAD, thereby ruling out ischemia. Medical management for HFrEF with GDMT including a beta-blocker resulted in a significant decrease in ventricular ectopy. He was discharged with plans for ambulatory cardiac monitoring and Cardiac MRI for further cardiomyopathy evaluation. Conclusion BCI is a clinical diagnosis made in patients with newly identified cardiac dysfunction in the setting of BTT. Since no diagnostic criteria exists, high clinical suspicion and extensive workup is necessary in this population to exclude alternative etiologies.

Volume

83

Issue

13

First Page

3233

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