Commotio cordis overview

Revision as of 19:47, 6 March 2013 by Shankar Kumar (talk | contribs)
Jump to navigation Jump to search

Commotio cordis Microchapters

Home

Patient Information

Overview

Pathophysiology

Causes

Differentiating Commotio cordis from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Primary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Commotio cordis overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Commotio cordis overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Commotio cordis overview

CDC on Commotio cordis overview

Commotio cordis overview in the news

Blogs on Commotio cordis overview

Directions to Hospitals Treating Commotio cordis

Risk calculators and risk factors for Commotio cordis overview

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

Template:WH Template:WS