Working Diagnosis:
Cardiac Contusion

Treatment:
Rest from sports and exercise.

Outcome:
This patient was held from all physical activity as his work-up continued. He was seen by a sports cardiologist. Ultimately, once his troponins normalized 2 weeks after the initial event, the patient was given clearance to return to full activity by the sports cardiologist. Cardiac MRI was deferred by sports cardiology given his normal echocardiogram.
This patient missed the rest of the high school football season; however, he returned to wrestling in the winter without any restrictions or complications moving forward.

Author's Comments:
Traumatic cardiac contusion is a rare but life-threatening condition. Patients are at increased risk of arrhythmias, particularly ventricular tachycardia and ventricular fibrillation, within the first 24-48 hours. They are also predisposed to cardiac arrest if they sustain further blunt trauma prior to myocardial recovery. Long-term complications include heart failure and valvular disease. While it is known that physical activity can lead to elevation in troponin, normal values in athletes post-exercise has not been studied. This patient's initial distress and presentation makes a cardiac contusion more likely. Interestingly, while Levine's Sign has not been found to be useful in detecting cardiac contusions, it is roughly 84% specific for cardiac ischemia.
While the magnitude of impact required to cause intrathoracic pathology is rare in sports, sports medicine physicians should consider cardiac and pulmonary abnormalities in the setting of blunt chest trauma. Furthermore, a portable ultrasound on the sideline can serve as a vital tool in aiding in the early recognition and diagnosis of emergent pathology.

Editor's Comments:
Blunt chest trauma can result in serious and life threatening injuries. A cardiac contusion, also known as a myocardial contusion, is a bruise to the heart muscle caused by blunt chest trauma. It's caused by a deceleration force that puts direct pressure on the myocardium and indirect pressure from increased intrathoracic pressures. Treatment depends on the complications that may happen after the injury, and recovery depends on the severity. Most people make a full recovery, but severe injuries can be fatal.

References:
Marcus GM, Cohen J, Varosy PD, Vessey J, Rose E, Massie BM, Chatterjee K, Waters D. The utility of gestures in patients with chest discomfort. Am J Med. 2007 Jan;120(1):83-9. doi: 10.1016/j.amjmed.2006.05.045. PMID: 17208083.

Yousef R, Carr JA. Blunt cardiac trauma: a review of the current knowledge and management. Ann Thorac Surg. 2014 Sep;98(3):1134-40. doi: 10.1016/j.athoracsur.2014.04.043. Epub 2014 Jul 25. PMID: 25069684.

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