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Chiropractic Research Review

Recognizing Myocardial Injury from Chest Trauma

Blunt chest trauma (BCT) most often occurs in car accidents and contact sports, and can cause potentially serious myocardial injury: Up to 25% of trauma deaths are the result of chest trauma.

The number of patients with BCT who are initially evaluated by chiropractors is unknown, but there are likely some who seek chiropractic care first - especially if they have suffered mild-to-moderate chest trauma and their symptoms seem minor. Successful treatment of BCT can depend on early recognition, before symptoms of cardiac sequelae are apparent.

This review of BCT covers the types of injuries and treatment recommendations for chiropractors. BCT injuries include heart or valve rupture; pericardial effusion; myocardial contusion; arrhythmias; and coronary artery injury leading to myocardial infarction. Some signs and symptoms related to BCT are chest pain; bruises or other physical marks on the chest; sternal fracture; tenderness to chest palpation; asymmetry of chest movement; altered heart rate/rhythm; nausea; difficulty breathing; and heart murmurs following a blow to the chest.

Forms of BCT relevant to the chiropractor include myocardial contusion and traumatic myocardial infarction (TMI), both of which may become evident hours after injury. TMI, myocardial concussion, and commotio cordis (the latter two usually involving sudden death) may be witnessed by a team chiropractor, on the other hand. It is important to note that CPR should immediately be administered in these cases.

Patients who have sustained BCT within the previous 72 hours should be referred to urgent care or the emergency room for ECG. X-rays do not successfully assess cardiac injuries. Although cardiac concussion sometimes occurs despite chest protection, the author recommends this prevention strategy in contact sports or those involving projectiles, as lethal BCT can occur in baseball, football, hockey, soccer, and other sports.

Note: This is an excellent review of blunt chest trauma for the practicing chiropractor. The full article should be read by those chiropractors who see patients with injuries from motor-vehicle accidents and contact sports.

Wells KA. Myocardial injury from blunt chest trauma: Implications for chiropractic practice. Journal of the Neuromusculoskeletal System 2001:9(4), pp. 122-128.

Chiropractic Research Review

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