Heart Injury Scale | Medicalalgorithms.com

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.

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