Traumatic injury to the heart can be graded based on the nature and extent of injury using the Heart Injury Scale.
Blunt Cardiac Injury |
Grade |
minor ECG abnormality |
I |
with heart block but without heart failure |
II |
with ischemic change but without heart failure |
II |
with sustained or multifocal ventricular contractions |
III |
septal rupture without heart failure |
III |
pulmonary or tricuspid valve incomptence without heart failure |
III |
papillary muscle dysfunction without heart failure |
III |
distal coronary arterial occlusion without heart failure |
III |
injury with cardiac failure |
III |
septal rupture with heart failure |
IV |
pulmonary or tricuspid valve incomptence with heart failure |
IV |
papillary muscle dysfunction with heart failure |
IV |
distal coronary arterial occlusion with heart failure |
IV |
aortic or mitral valve incompetence |
IV |
injury to right ventricle |
IV |
injury to right atrium |
IV |
injury to left atrium |
IV |
with proximal coronary arterial occlusion |
V |
left ventricular perforation |
V |
avulsion of the heart |
VI |
where:
• minor ECG changes include nonspecific ST or T wave changes, premature atrial or ventricular contraction or persistent sinus tachycardia
• heart block changes include right or left bundle branch, left anterior fascicular, or atrioventricular
• ischemic changes include ST depression or T wave inversion
• sustained ventricular contractions: >= 5 beats/minute
Penetrating Cardiac Injury |
Grade |
tangential penetration up to but not penetrating through the endocardium, without tamponade |
II |
septal rupture without heart failure |
III |
pulmonary or tricuspid valve incomptence without heart failure |
III |
papillary muscle dysfunction without heart failure |
III |
distal coronary arterial occlusion without heart failure |
III |
tangential penetration up to but not penetrating through the endocardium, with tamponade |
III |
septal rupture with heart failure |
IV |
pulmonary or tricuspid valve incomptence with heart failure |
IV |
papillary muscle dysfunction with heart failure |
IV |
distal coronary arterial occlusion with heart failure |
IV |
aortic or mitral valve incompetence |
IV |
single injury to right ventricle |
IV |
single injury to right atrium |
IV |
single injury to left atrium |
IV |
with proximal coronary arterial occlusion |
V |
single injury to left ventricle with perforation |
V |
stellate wound with < 50% tissue loss of right ventricle |
V |
stellate wound with < 50% tissue loss of right atrium |
V |
stellate wound with < 50% tissue loss of left atrium |
V |
multiple injuries to right ventricle |
V |
multiple injuries to right atrium |
V |
multiple injuries to left atrium |
V |
multiple injuries to left ventricle |
VI |
penetrating wound with > 50% loss of a chamber |
VI |
where:
• The presence of multiple penetrating injuries to a single chamber increases the grade by 1.
Blunt Pericardial Injury |
Grade |
without cardiac injury, tamponade or cardiac herniation |
I |
with laceration and cardiac herniation |
III |
Penetrating Pericardial Injury |
Grade |
without cardiac injury, tamponade or cardiac herniation |
I |
with laceration and cardiac herniation |
III |
NOTE: I did not see an entry for pericardial injury with tamponade. There is tamponade associated with tangential penetrating injury.
The score is advanced by 1 grade if multiple chambers involved.
Specialty: Surgery, orthopedic, Emergency Medicine, Critical Care, Surgery, general, Cardiology
ICD-10: ,