People may feel that their heart is pounding or racing, feel short of breath, or have dangerously low blood pressure.
Electrocardiography (ECG) and ultrasonography of the heart (echocardiography) are done.
People who have an abnormal heart rhythm (heartbeats that are too fast, too slow, or irregular) are admitted to the hospital so that the rhythm can be monitored continuously.
People who have damage to a heart valve or a tear in the heart's wall usually require surgery.
(See also Introduction to Chest Injuries Introduction to Chest Injuries Chest injuries most often affect the ribs, upper part of the abdomen, lungs, blood vessels, heart, muscles, soft tissues, and breastbone. Sometimes the esophagus, collarbone, or shoulder blade... read more .)
A blunt injury is a forceful blow that does not penetrate the skin. Blunt injuries to the heart can be caused by a motor vehicle crash, a fall from a height, or less often a direct blow.
If the heart is severely injured, people often die before they can be treated. However, many injuries worsen over hours or even longer.
A bruise to the heart muscle (myocardial contusion) may disrupt the heart's normal, rhythmic beating, making heartbeats too fast, too slow, or irregular (arrhythmia Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more 
).
A tear in the wall of the heart (ventricular rupture) often causes fatal bleeding before people can be taken to a hospital. However, bleeding from a small tear is sometimes contained by the membrane around the heart (pericardium) long enough for people to receive treatment. Such blood collected around the heart can interfere with the heart's ability to fill with blood (see Cardiac Tamponade Cardiac Tamponade Cardiac tamponade is pressure on the heart by blood or fluid that accumulates in the two-layered sac around the heart (pericardium). This disorder interferes with the heart's ability to pump... read more ).
Damage to a heart valve can cause heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more 
.
Rarely, a tear in the membrane that separates two chambers of the heart (septal rupture) may occur. Such a tear may not cause symptoms until some time after a blunt injury. The person may then develop heart failure.
Commotio cordis
Commotio cordis is the sudden stopping of the heart (cardiac arrest Cardiac Arrest and CPR Cardiac arrest is when the heart stops pumping blood and oxygen to the brain and other organs and tissues. Sometimes a person can be revived after cardiac arrest, particularly if treatment is... read more 
) caused by a blow to the front of the chest. Typically, this blow involves a hard object that is moving fast (such as a baseball or a hockey puck). Thus, commotio cordis usually occurs during sports activities in young people.
The exact reason for cardiac arrest is unclear, but commotio cordis does not result from an underlying heart disorder or from physical damage to the heart muscle. Some experts think that cardiac arrest occurs because the blow occurs at a critical moment during the cycle that produces each heartbeat. The blow then disrupts the electrical signals that keep the heart pumping continuously and regularly.
Symptoms of Blunt Cardiac Injury
A blunt injury to the heart can cause various symptoms. Most people have pain and often bruising or other injuries around the breastbone or ribs. Some people have symptoms of heart failure, such as shortness of breath. People may go into shock Open Pneumothorax An open pneumothorax occurs when air accumulates between the chest wall and the lung as the result of an open chest wound or other physical defect. The larger the opening, the greater the degree... read more . Their skin may be sweaty, cool, and bluish, and blood pressure may be dangerously low. Heart rhythms may be abnormal. People may feel that their heart is pounding, racing, or beating abnormally (palpitations).
Diagnosis of Blunt Cardiac Injury
Electrocardiography (ECG) and echocardiography
If people might have a blunt heart injury, an ECG Electrocardiography Electrocardiography (ECG) is a quick, simple, painless procedure in which the heart’s electrical impulses are amplified and recorded. This record, the electrocardiogram (also known as an ECG)... read more 
is usually done to check for abnormal heart rhythms. Sometimes doctors also check the blood for substances (serum markers) released by the damaged heart.
Echocardiography Echocardiography and Other Ultrasound Procedures Ultrasonography uses high-frequency (ultrasound) waves bounced off internal structures to produce a moving image. It uses no x-rays. Ultrasonography of the heart (echocardiography) is one of... read more 
is done, sometimes in the emergency department. Echocardiography may show abnormalities in the way the heart's walls move. It may also show blood or fluid around the heart, or rupture of a heart wall, or damage to a heart valve.
Treatment of Blunt Cardiac Injury
Treatment of related problems, such as abnormal rhythms, heart failure, or cardiac arrest
People with an abnormal heart rhythm Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more are kept in the hospital for monitoring because the abnormal heart rhythm may suddenly become serious.
If a blunt injury to the heart causes other problems (such as heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more or a damaged heart valve), people are admitted to the hospital, and the problem is treated.
People who collapse after a blunt blow to the chest must be evaluated immediately to see if they are in cardiac arrest Cardiac Arrest and CPR Cardiac arrest is when the heart stops pumping blood and oxygen to the brain and other organs and tissues. Sometimes a person can be revived after cardiac arrest, particularly if treatment is... read more . If they are in cardiac arrest, cardiopulmonary resuscitation First-Aid Treatment for Cardiac Arrest Cardiac arrest is when the heart stops pumping blood and oxygen to the brain and other organs and tissues. Sometimes a person can be revived after cardiac arrest, particularly if treatment is... read more is started as soon as possible and an automated external defibrillator Automated External Defibrillator: Jump-Starting the Heart 
(AED) is used if available. About 35% of people who are treated with an AED survive.
Several measures may help prevent commotio cordis. They include teaching players ways to protect themselves (certain defensive strategies), using chest protectors and softer baseballs, and having AEDs and trained emergency medical personnel at youth sporting events.
