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Commotio Cordis

Commotio Cordis is a rare phenomenon and can be highly deadly when a heart rhythm disruption occurs as a direct result of a blow directly over the heart. This hit to the chest occurs at a critical time during the cycle of a heartbeat. There is a disruption of normal heart electrical activity as a result. The heart is often thrown into ventricular fibrillation, which then disorganizes the heart’s ability to pump blood. This series of events will often lead to cardiac arrest.

This is a very rare occurrence with less than 20 cases per year in the United States. It is often seen in boys participating in sports – most commonly baseball and a hard ball striking an unprotected chest. The time window where the impact of the chest would cause this is about 40 milliseconds in the cardiac electrical cycle.

If CPR (cardiopulmonary resuscitation) occurs quickly – this can be lifesaving. The use of an on-site automated external defibrillator is also extremely important. If the two – life-saving – modalities are used – the survival from commotio cordis goes up to nearly 58%.

Incidence

This condition happens infrequently and the average age is a 15-year-old boy. Girls can be affected as well. It can happen in older men and women, but it is even rarer. It can occur during any sporting event where something could strike the chest of the player. Often, there is not an underlining cardiac problem.

During a study from 1993-2006 – the survival rate was 34%

Adding in CPR and defibrillators – a study from 2006-2012 – showed an increase in the survival rate to 58%

Risk for Death

There is a substantial risk of sudden cardiac death due to ventricular fibrillation and loss of cardiac output to vital organs. This points to the importance of immediate treatment with CPR.

Potential Causes:

1.) Sports: Baseball, American Football, Soccer, Ice Hockey, Polo, Rugby, Cricket, Softball, Boxing, Lacrosse, others

2.) Impact Factors: Car accident, Falls,

3.) Others: Abuse, Torture, etc

Mechanism

When the impact of the chest occurs on a narrow band of the ECG during the upslope of the T wave (40 Milliseconds) and before the peak of the T wave, this can cause the ventricular fibrillation of commotio cordis.

The three primary factors involved include:

1.)  Direction of the impact of the precordium

2.) The applied energy involved

3.) The impact occurrence with a specific 10- to 30-ms portion of the cardiac cycle

Treatment

1.) Immediate CPR allows for the greatest chance of survival

2.) Use of on-site automated external defibrillator is also important

3.) Immediate transport to hospital.

4.) Oxygen breathing, ventilator, emergency medical treatment