Commotio cordis overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Commotio cordis (from Latin commotion of the heart - a functional effect of mechanical stimulation in the absence of structural damage, as opposed to myocardial contusion which involves tissue damage) is a sudden disturbance of heart rhythm observed nowadays mostly in young people during participation in sports. It occurs as the result of a blunt, non-penetrating impact to the precordial region, often caused by impact of a ball, a bat or other projectile. The impact is transmitted to the heart muscle, and depending on the precise timing in relation to the cardiac cycle, it may affect the heart's electrical activity, causing an arrhythmia, such as an ectopic beat, ventricular tachycardia or ventricular fibrillation.

Pre-existing conditions, such as undetected electrical or structural abnormalities in the heart of these individuals, have been speculated to render individuals more vulnerable, but this view is not currently corroborated by hard evidence. The phenomenon was confirmed experimentally in the 1930s, with research in anaesthetized rabbits, cats and dogs[1][2].

Epidemiology and Demographics

Commotio cordis is a very rare event, but nonetheless is often considered when an athlete presents with sudden cardiac death. Some of the sports which have a risk for this cause of trauma are baseball, soccer, ice hockey, polo, rugby, cricket, softball, pelota, fencing, lacrosse, boxing, karate, kung fu and other martial arts. Children are especially vulnerable due to their more fragile thoracic skeleton. The USA Commotio Cordis Registry had more than 130 cases recorded by September 2001, with most of the cases occurring in Little League baseball, lacrosse and softball. The real number of cases may be much larger.

Risk Factors

Young athletes who are involved in sports such as baseball, soccer, ice hockey, polo, rugby, cricket, softball, pelota, fencing, lacrosse, boxing, karate, kung fu and other martial arts where there is a likelihood of sustaining blow to the chest.

Natural History, Complications and Prognosis

Commotio cordis has a poor prognosis with only about a quarter of these victims surviving after immediate resuscitation.

Treatment

Medical Therapy

Fulminant death is the most common outcome, because cardiopulmonary resuscitation requires quick action by a specialized medical team, using a defibrillator and cardioactive drugs, and these are rarely on hand in sports arenas. Due to the significant danger to children (death by commotio cordis is the first cause of fatalities in youth baseball in the US, with 2 to 3 deaths per year[3], it has been recommended that "communities and school districts reexamine the need for accessible automatic defibrillators and cardiopulmonary resuscitation-trained coaches at organized sporting events for children[4]."

References

  1. Schlomka G. Commotio cordis und ihre Folgen. Die Einwirkung stumpfer Brustwandtraumen auf das Herz. Ergebnisse der inneren Medizin und Kinderheilkunde. 1934;47: 1-91.
  2. An open access article on Commotio Cordis
  3. Abrunzo TJ. Commotio cordis. The single, most common cause of traumatic death in youth baseball. Am J Dis Child. 1991 Nov;145(11):1279-82. Review. PMID 1951221
  4. Salib EA, Cyran SE, Cilley RE, Maron BJ, Thomas NJ. Efficacy of bystander cardiopulmonary resuscitation and out-of-hospital automated external defibrillation as life-saving therapy in commotio cordis. J Pediatr. 2005 Dec;147(6):863-6. Review. PMID 16356450

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