Commotio Cordis

Emergency medicine & sports medicine physicians often cover sporting events where athletes are at risk of commotio cordis

• 2nd most common cause of sudden cardiac death in young athletes in the US (HCM #1)
• Young males between 4 and 18 years old are at greatest risk
• 50% of all cases occur during competitive sports (baseball #1)
• Nonpenetrating, blunt trauma to the chest resulting to cardiac arrhythmia and, often, sudden cardiac  death.
• Ventricular fibrillation (VF) is the most common arrhythmia.
• Thought to occur secondary to a precordial impact during an electrically vulnerable portion of ventricular repolarization (10-30 msec before the T-wave peak)
• Treatment:  Immediate chest compressions and early use of an automated external defibrillator (AED) ((effective in only 15% of cases))
• Survival is much improved if resuscitation administered within 3 minutes (25%) than after 3 minutes (3%)
• Differential diagnosis: other causes of sudden cardiac death including HCM, coronary artery anomalies, long QT syndrome, Brugada syndrome, WPW, CAD, myocarditis, arrhythmogenic right ventricular dysplasia

References

Palacio LE, Link MS. Commotio Cordis. 2009.