Not all abnormally moving or thickening myocardium is indicative of permanent damage. Myocardial muscle may simply be stunned or hibernating. Function will spontaneously return to normal on its own if this is the cause of poor muscle contraction (191,199–202).

Myocardial Contusions

Myocardial contusions and traumatic myocarditis resulting from trauma may also impair myocardial function. Features seen echocardiographically on two-dimensional images include increased diastolic wall or septal thickness in the affected segment, increased echogenicity of the affected myocardium, and decreased systolic thickening in the affected area. There may also be pericardial effusion and hypoechoic areas due to hematoma within the myocardium (203,204). The increased wall thickness is associated with edema of the injured muscle, and the increased echogenicity is the result of hemorrhage and altered tissue structure. Studies show that myocardial perfusion remains normal or may actually increase and that ischemia is not responsible for the decrease in thickening of the affected area. The effect is similar to that of stunned myocardium, and function will spontaneously return with time. The poor function may be related to edema and hemorrhage in the area creating less myocardial compliance within the affected segment (203,204).

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