Commotio cordis
| Commotio cordis | |
|---|---|
 |
|
| Human adult thorax, showing the outline of the heart (in red). The sensitive zone for mechanical induction of heart rhythm disturbances lies between the 2nd and the 4th ribs, to the left of the sternum | |
| Classification and external resources | |
| Specialty | emergency medicine |
| ICD-10 | S26 |
| DiseasesDB | 35055 |
| eMedicine | ped/3019 |
Commotio cordis (Latin, "agitation of the heart") is an often lethal disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart (the precordial region), at a critical time during the cycle of a heart beat causing cardiac arrest. It is a form of ventricular fibrillation (V-Fib), not mechanical damage to the heart muscle or surrounding organs, and not the result of heart disease. The fatality rate is about 65% even with prompt CPR and defibrillation, and more than 80% without.
Commotio cordis occurs mostly in boys and young men (average age 15), usually during sports, most frequently baseball, often despite a chest protector. It is usually caused by a projectile, but can also be caused by the blow of an elbow or other body part. Being less developed, the thorax of an adolescent is likely more prone to this injury given the circumstances.
The phenomenon was confirmed experimentally in the 1930s, with research in anaesthetized rabbits, cats and dogs.
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, american football, association football, ice hockey, polo, rugby football, cricket, softball, pelota, fencing, lacrosse, boxing, karate, kung fu, and other martial arts. Children are especially vulnerable, possibly due to the mechanical properties of their thoracic skeleton. From 1996 to spring 2007, the USA National Commotio Cordis Registry had 188 cases recorded, with about half occurring during organized sports. Almost all (96%) of the victims were male, the mean age of the victims during that period was 14.7 years, and fewer than one in five survived the incident.
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