A prospective evaluation of myocardial contusion: correlation of significant arrhythmias and cardiac output with CPK-MB measurements

J Trauma. 1991 May;31(5):653-9; discussion 659-60.


Over a nine-month period, patients with chest trauma were prospectively evaluated for myocardial contusion. Ninety-two patients with evidence of anterior chest trauma were entered into the study and had 1) an ECG on admission and daily for three days; 2) monitoring of the myocardial band fraction of creatine phosphokinase (CPK-MB) on admission and every eight hours for 24 hours; 3) continuous electrocardiographic Holter monitoring for three to five days; and 4) noninvasive pulsed-Doppler cardiac output measurements daily for three days. Twenty-three patients developed 25 significant arrhythmias (SARRs): 1 atrial fibrillation, 1 AV dissociation, 5 supraventricular tachycardias, and 18 paroxysmal ventricular tachycardias. Cardiac outputs were significantly higher in those patients without SARRs. The CPK-MB levels correlated with the SARRs but were neither sensitive nor specific. No patients required specific therapy and none developed adverse sequelae of the SARRs. We conclude that 1) CPK-MB monitoring should not be routinely used for screening and diagnosis; 2) continuous arrhythmia monitoring deserves further clinical investigation but not routine application; 3) stable patients at risk for myocardial contusion should be monitored for 24 hours; and 4) the Abbreviated Injury Score for "minor" myocardial contusion should be deleted for purposes of ISS tabulation.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Arrhythmias, Cardiac / etiology
  • Cardiac Output
  • Contusions / physiopathology*
  • Creatine Kinase / blood
  • Electrocardiography, Ambulatory
  • Female
  • Heart Injuries / complications
  • Heart Injuries / enzymology
  • Heart Injuries / physiopathology*
  • Humans
  • Isoenzymes
  • Male
  • Middle Aged
  • Prospective Studies
  • Thoracic Injuries / physiopathology*


  • Isoenzymes
  • Creatine Kinase