| Abstract: | Cardiac contusion was suspected in 95 patients with severe blunt chest trauma of whom 93 did not require hospitalization. Creatine kinase (CK) MB isoenzyme activity was elevated over 4.0 U/l in 10 (10.5%) patients (CK MB positive) by between 2% and 8% (mean +/- SE 4.1 +/- 0.6%), when the total CK was 296 +/- 74 (mean +/- SE). Two patients had a pericardial rub. M-mode echocardiography was performed on 16 patients: 7 CK MB positive (CK MB+) and 9 CK MB negative (CK MB-) without the physician's knowledge of the CK MB status of the patients. The left ventricular end-diastolic diameter, in healthy subjects 48.3 +/- 4.9 mm, was increased to 55.4 +/- 1.8 mm (p less than 0.01) in CK MB+ patients and to 56.3 +/- 6.0 mm (p less than 0.01) in CK MB- patients. The end-systolic left ventricular diameter, in healthy subjects 36.7 +/- 5.2 mm, was increased to 42.4 +/- 6.7 mm (p less than 0.01) in CK MB+ patients and to 41.3 +/- 6.5 mm (p less than 0.01) in CK MB- patients. The mean ejection fraction was 48.6 +/- 11.0 in CK MB+ and 53.6 +/- 11.8 in CK MB- group. Minor contractile abnormalities occurred in all CK MB+ patients in 2 or more left ventricular regions and in 7 out of 9 CK MB- patients in 1 or 2 regions. The regional motion pattern was hypokinesia with sharp systolic deflections at abnormal areas and hyperkinesia on normal segments. Aortic root was enlarged in all patients with contusion and CK MB+. There was no apparent increase in left atrial size. "Flattened" ST-segment and T-waves were seen in 5 CK MB+ patients but not in the CK MB- patients.(ABSTRACT TRUNCATED AT 250 WORDS) |
