Commotio cordis is a very rare cause of cardiac arrest in otherwise healthy younger people, typically athletes during sport when there is a direct blow to the chest. It occurs when the direct blunt trauma is to the left chest wall over the cardiac silhouette when the heart is in the early T wave of the cardiac cycle:
Electrocardiograph showing the portion of normal sinus rhythm during which commotio cordis is a risk if a severe chest impact occurs within the narrow vulnerability window. From Wikipedia.
This can happen in sports like baseball (direct blow from the ball), football (direct impact from a helmet during a tackle) and ice hockey (a blow from the puck or a hockey stick). The impact leads to a ventricular fibrillation.
10 to 20 cases are reported each year to the Commotio Cordis Registry in the USA with a mean age of 15 in 2010 (link). Males are much more affected and is probably due to the nature of the sports participation.
Clinical Features:
Sudden collapse; unresponsive; pulselessness; no heartbeat.
Maybe cyanosis and grand mal seizures.
Some will have localized bruising from the impact.
Differential diagnosis: Contusio cordis (cardiac contusion) – the trauma causes structural cardiac damage (eg typically in motor vehicular accidents); hypertrophic cardiomyopathy; long QT syndrome
Management:
CPR needs to be started immediately and the use of an AED.
Transport to hospital.
Medications may be needed to treat any residual arrhythmia’s following CPR and AED (eg beta blockers such as atenolol).
Survival is around 50% but is dependent on how soon the CPR is started and the AED used.
Prevention:
Protective padding.
Softer balls.
Teaching the technique of turning the body away from potential direct blows to the chest.
Commentary:
- Commotio cordis received publicity in the news media when on 2 January 2023, NFL player Damar Hamlin collapsed during a game between his team, the Buffalo Bills and the Cincinnati Bengals with a cardiac arrest after being hit in the chest by an opponents helmet in a tackle. CPR was started immediately and an AED used. He was transported to hospital and released a few days later. No information was released about the diagnosis of his condition, with most experts assuming that it was commotio cordis.
- The anti-covid-19 vaccination cult within minutes of this occurring were blaming the vaccine for his sudden collapse when no information had been released about his condition. It was not the vaccine and commotio cordis had been occurring in young healthy athletes well before the vaccine and there has not been an increase in the number of cases since the vaccine. The cases of sudden collapse of healthy people that have occurred since the introduction of the vaccine have just got more publicity becasue of the false claims being made about them.
- See:
Damar Hamlin suffers cardiac arrest on field — anti-vaxxers go nuts
NFL Player Damar Hamlin’s Cardiac Arrest Triggers Unfounded Social Media Claims
How antivaxxers laid the groundwork to blame COVID-19 vaccines for Damar Hamlin’s cardiac arrest.
Damar Hamlin confirmed on April 18, 2023 that he has been cleared to resume playing and that it was indeed commotio cordis:
“The diagnosis of what happened to me was basically commotio cordis. It’s a direct blow at a specific point in your heartbeat that causes cardiac arrest,” Hamlin added. “And five to seven seconds later, you fall out. … Commotio cordis is the leading cause of death in youth athletes across all sports. So, that’s something that I personally will be taking a step in to make a change. Also, with that being said, all of the awareness around CPR and access to AEDs have been lowering that number as well.” (LINK)
Related Topics:
Sudden Cardiac Death in the Young and Athletes
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