DrVirgo
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Which of the following is the most appropriate study to establish the diagnosis of myocardial contusion?
A. Cardiac Enzymes
B. Chest-XRay
C. Echo
D. MRI
E. Radionucleotide Scan
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| multifactorial
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should be cardiac enzymes.
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| cool doctor
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its ECG
but among these I will choose A
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| farnsworth
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echocardiography! fast and reliable, especially transesophageal echocardiography (TEE). it is the preferred diagnostic tool for unstable patients, if the patient goes to the operating room, TEE would be the tool for monitoring the patients' hemodynamics (as well as RVOT, valves, akinesias/dyskinesias), whereas cardiac enzymes do not reflect the myocardial function (apart from lagging behind!)
if the patient is stable, he can be admitted to monitored bed (serial ECGs, cardiac troponin)
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| viket
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echo
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| DrVirgo
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Given answer was
E. Radionucleotide Scan 
However Kap Surg notes say Tropinins are specific. So I thought it was Enzymes....
Whats going on here????
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| farnsworth
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Radionucleotide scans? They are neither useful in the evaluation of blunt thoracic trauma nor are they related to complications (Maenza et al, Am J Emerg Med 1996 (!!!);14:237–41).
Cardiac enzymes are not specific for myocardial contusion, but they are useful for detecting any type of myocardial damage (ischemia etc): high sensitivity!
In an hemodynamically unstable patient you can do a TEE, while someone else does an abdominal ultrasound to rule out parenchymatous organ damage (and free fluid within the abdominal cavity). It's a matter of minutes. Thereafter you may decide: operating room or further diagnostics (CT).
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| RX 135
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most accurate of them all is direct visualisation wat he says in tapes..enzymes non specific can be from other
contused muscle
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| RX 135
tormenta
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direct visualisation never done
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| DrVirgo
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RX 135 wrote:
most accurate of them all is direct visualisation wat he says in tapes..enzymes non specific can be from other
contused muscle
direct visualization by which test?
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| hero
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While elevated serum troponin I levels correlate with the presence of echocardiographic or electrocardiographic abnormalities in patients with significant blunt cardiac injuries, these levels have low sensitivity and predictive values in diagnosing myocardial contusion in those without. As such, troponin I level determination does not, by itself, help predict the occurrence of complications that may require admission to the hospital. Accordingly, their routine use in this clinical situation is not well supported.
Creatine kinase-MB levels is frequently performed in patients with possible blunt myocardial injuries. The test is rapid and inexpensive. This diagnostic modality has recently been criticized because of poor sensitivity, specificity, and positive predictive value in relation to clinically significant blunt myocardial injuries.
Ultrasound examinations of the pericardium, heart, and thoracic cavities can be expeditiously performed by surgeons and emergency department (ED) physicians within the ED. Pericardial effusions or tamponade can be reliably recognized, as can hemothoraces associated with trauma. The sensitivity, specificity, and overall accuracy of ultrasound in these settings are all more than 90%.
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| hero
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While the term "myocardial contusion" can have different meanings, for the purposes of this discussion, it will be reserved for the following: "a blunt chest injury with cardiac sequelae, including arrhythmias, pump failure, and sudden death."
Blunt cardiac injury is usually diagnosed in the context of severe multiple system trauma and is less commonly an isolated event. Because of the lack of a standard approach to diagnosis, various approaches have been advocated in the diagnosis of blunt cardiac injury or myocardial contusion. According to ATLS teaching, an exact diagnosis of myocardial contusion can only be established by direct inspection of the myocardium.
Three separate meta-analytic approaches were performed: 1 included only the prospective studies, 1 only the retrospective studies, and 1 with all studies combined. All approaches were similar in their findings, the key ones being: a) an abnormal electrocardiogram and an abnormal creatine phosphokinase of muscle band (CPK-MB) directly correlated with complications requiring treatment; b) conversely, a normal ECG and CPK-MB correlated with the lack of clinically significant complications; and c) other studies, for example radionuclide scans, did not correlate with complications.
full text here
http://www.medscape.com/viewarticle/434219
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| drduck
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A
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