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What Is a Myocardial Contusion?

Medically Reviewed by Melinda Ratini, DO, MS on May 19, 2021

A myocardial contusion is a bruise to your heart muscle. It's caused by blunt force to your chest. It may tear the wall of your heart or damage your heart valve.

What Causes a Myocardial Contusion?

A myocardial contusion happens as a result of blunt force trauma. Your heart is well-protected by the bones of your chest, so it takes a lot of force to damage it. The most common causes are:

  • Falling from a height greater than 20 feet
  • Car crashes
  • Chest compressions performed during cardiopulmonary resuscitation (CPR)
  • Getting hit by a car
  • Sports injuries
  • Crush injuries

What Are the Symptoms of a Myocardial Contusion?

A myocardial contusion can cause different symptoms. Some possible symptoms include:

  • Pain and bruising around the breastbone or ribs
  • Other injuries around the chest
  • Shortness of breath
  • Sweaty, cool, or bluish skin
  • Dangerously low blood pressure
  • Abnormal heart rhythm
  • Pounding, racing, or irregular heartbeats
  • Shock

How Is A Myocardial Contusion Diagnosed?

Your doctor will listen to your symptoms and do a physical exam. When they're doing an exam, they'll look for: 

  • Irregular heartbeat
  • Low blood pressure
  • Shallow, rapid breathing
  • Chest tenderness
  • Bruises or scrapes on your chest
  • A crunching sensation if your ribs are broken or your lung is punctured

Your doctor may also order tests to help confirm a diagnosis, including:  

These tests will help your doctor determine if your heart has been damaged and how it needs to be treated. Myocardial contusions can range from mild to severe.

Possible Complications of a Myocardial Contusion

Some complications of myocardial contusion show up soon after you're injured. These are called early complications. These can include:

  • Irregular heartbeat
  • Rupture of the heart wall
  • Rupture of the ventricular septum, which is the wall separating the two lower chambers of the heart
  • Valvular insufficiency, which is when your heart valve doesn't close completely and blood flows backward
  • Blood clot in your heart
  • Myocardial infarction, which is commonly called a heart attack

Some complications may not show up until a while after your injury. These can include: 

  • Ventricular aneurysm, which is a blood-filled bulge in the heart wall
  • Chronic dilated cardiac dysfunction, which causes your heart to pump blood less efficiently
  • Constrictive pericarditis, which is a chronic inflammatory process
  • An irregular heart rhythm caused by scar tissue on your heart

Risks Associated with a Myocardial Contusion

A particular type of injury that results from blunt trauma to the chest is commotio cordis. This type of injury doesn't cause direct damage to the heart muscle. Instead, blunt trauma, such as the kind that occurs when the left side of the chest is hit with a baseball, interrupts the heart's rhythm. This causes sudden cardiac arrest in an otherwise structurally normal heart.

Commotio cordis is a leading cause of death in young athletes. It happens most often in children. It could happen to children more often because they have a thinner chest wall or because they're more likely to play sports that result in this type of trauma. Commotio cordis should be treated immediately with an automated external defibrillator (AED). 

Some tips to prevent and improve survival rates of commotio cordis include:

  • Children should use age-appropriate safety baseballs.
  • Children should use chest protectors.
  • Rules and coaching techniques should focus on reducing chest blows.
  • Coaches and other adults should be trained to recognize commotio cordis and how to resuscitate players.
  • All sporting arenas should have an accessible AED.
  • If possible, a healthcare provider should be available during sporting events to advise and assist in emergencies.

How Is a Myocardial Contusion Treated?

You will probably be closely monitored for at least 24 hours. You will probably have a continuous electrocardiogram done to check your heart function. Other treatment options may include the following, as needed:

  • Medicine to relieve pain
  • Medicine for low blood pressure
  • Medicine for a heart rate disturbance
  • Pacemaker
  • Oxygen
  • Chest tube
  • Drainage of blood around the heart
  • Surgery to repair your heart

Preventing Myocardial Contusion

Not all myocardial contusions can be prevented. However, the following tips may help: 

  • Always wear a seatbelt.
  • Choose a car with airbags.
  • Follow safety regulations when working at heights.
  • Wear protective equipment during sports.
WebMD Medical Reference

Sources

SOURCES:

Heart: "Diagnosing cardiac contusion: old wisdom and new insights."

Merck Manual: "Blunt Injury to the Heart."

Mount Sinai: "Myocardial contusion."

StatPearls [Internet]: "Commotio Cordis."

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