What's with Commotio Cordis?

THE SHORT FORM:

When someone gets hit hard in the chest in the area of the heart, cardiac arrest can result. This is one source of cardiac arrest in young athletes. Only about a quarter of these victims survive. Those that do survive are associated with immediate CPR and prompt defibrillation. Congenital defects can also cause these events.

Key points:

• Ask your doctor about a though review of your child's heart before permitting that child to participate in sports where being struct in the chest hard is a possibility or where a congenital defect might cause a problem under conditions where high levels of exertion might be encountered.
• Make sure that the trainer or coach that is present for all practices and games is trained in CPR and AED use.
• Make sure that there is an AED on hand at all practices and games. Don't accept an answer of "We only take the AED to games, not practices."

THE DETAILS:

Newspaper reports of young athletes going into cardiac arrest are becoming more common. One of several possible reasons for these arrests is 'commotio cordis' a condition that results from an impact on the chest wall in the area of the heart during a specific part of the heartbeat. (30-40 ms before the peak of the T-wave.)

Such an impact can cause a premature ventricular depolarization, leading to ventricular fibrillation, and subsequently, cardiac arrest. (see Link MS, Maron BJ, Wang PJ, et al. Upper and lower limits of vulnerability to sudden arrhythmic death with chest-wall impact (commotio cordis). J Am Coll Cardiol. Jan 1 2003;41(1):99-104.}

Some other possible causes of these tragic events are congenital abnormalities such as enlarged heart, abnormal structure of the coronary arteries, and longer than normal time between the Q-wave and the T-wave,

About one quarter of these stricken athletes survive to discharge with major brain function intact. (see Maron, BJ: Clinical Features of Commotio Cordis. Presentation of Registry Data at Heart Rhythm Society Scientific Sessions [database online]. Boston, Massachusetts: May 15, 2009.)

Although commotio cordis usually involves impact from a baseball, it has also been reported during hockey, softball, lacrosse, karate, and other sports activities in which a relatively hard and compact projectile or bodily contact caused impact to the person's precordium. (teven M Yabek, MD, FAAP, FACC, Pediatrix Cardiology Associates of New Mexico (a Division of Mednax Medical Group), Presbyterian Hospital Medical Center)