Commotio cordis causes

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Commotio cordis may occur also in other situations, such as in children who are punished with blows over the precordium, cases of torture, frontal collisions of motor vehicles (the impact of the steering wheel against the thorax, although this has decreased substantially with the use of safety belts and air bags).

Cases of commotio cordis have been recorded in people who were shot by firearms over the precordium and were using body armour[1], thus stopping the bullet but causing a mechanical impact to the thorax (the so-called Behind Armour Blunt Trauma or BABT); or after being hit by less-lethal crowd control firearm shots using rubber bullets or plastic bullets[2].

In contrast, the precordial thump (hard blows given over the precordium with a closed fist in order to revert cardiac arrest) is a sanctioned procedure for emergency resuscitation by trained health professionals witnessing a monitored arrest when no equipment is at hand, endorsed by the latest guidelines of the International Liaison Committee on Resuscitation. It has been discussed controversially, as - in particular in severe hypoxia- it may cause the opposite effect (i.e., a worsening of rhythm- commotio cordis). In a normal adult, the energy range involved in the precordial thump is 5-10 times below that associated with commotio cordis[3].


  1. Cannon L. Behind armour blunt trauma--an emerging problem. J R Army Med Corps. 2001 Feb;147(1):87-96. Review. PMID 11307682
  2. Hiss J, Hellman FN, Kahana T. Rubber and plastic ammunition lethal injuries: the Israeli experience. Med Sci Law. 1997 Apr;37(2):139-44. PMID 9149508
  3. Kohl P, Sachs F & Franz M (eds): Cardiac Mechano-Electric Feedback and Arrhythmias: from Pipette to Patient. Elsevier (Saunders), Philadelphia 2005 ISBN 9781416000341