Treatment of cardiac contusion: experimental basis for pathogenetic therapy and emerging approaches in cardioprotection

Myocardial contusion is a serious consequence of blunt thoracic trauma, most commonly resulting from traffic accidents, falls, sports injuries, and combatrelated events. It is associated with impaired myocardial contractility, fibrosis, and systemic inflammation, and carries a high risk of complications, with mortality rates reaching up to 10%. Despite advances in understanding the pathogenesis, the development of effective therapeutic strategies remains a key priority in experimental cardiology. A promising direction involves the development of targeted approaches that address both myocardial injury and the optimization of adaptive responses. The first aspect focuses on counteracting bioenergetic hypoxia, restoring energy and ionic homeostasis, suppressing secondary damage in the context of inflammation, and regulating apoptosis and autophagy. The second aspect targets the modulation of stress-activating and stress-limiting systems, including tissue-level adaptation mechanisms. Particular attention has been given to cardioprotective agents, which have demonstrated efficacy in ischemic heart disease, myocardial infarction, and ischemia–reperfusion injury. However, their impact on post-traumatic myocardial remodeling remains insufficiently explored. Phytopreparations from the Chinese Pharmacopoeia, characterized by multitarget activity on key pathological processes — such as bioenergetic deficiency, oxidative stress, and dysregulation of cellular homeostasis — may offer a viable alternative. Integrated strategies combining anti-inflammatory effects, metabolic support, and control of fibrogenesis may enhance therapeutic outcomes. Further research is necessary to assess the synergistic interactions of individual components, dose-dependent responses, and the long-term impact on myocardial structure and function. Multimodal approaches may improve therapeutic efficacy and help overcome the limitations of monotherapy, opening new avenues for the management of post-traumatic cardiac complications.