Commotio cordis

Commotio cordis

Commotio cordis, also known as cardiac concussion, is a rare but potentially fatal condition caused by blunt force trauma to the chest. The term "commotio cordis" comes from the Latin words "commotio" meaning disturbance or concussion, and "cordis" meaning heart. It is most commonly seen in young athletes participating in sports such as baseball, hockey, lacrosse, and martial arts.

Mechanism of injury

Commotio cordis

Commotio cordis occurs when a sudden blow to the chest occurs during a specific portion of the cardiac cycle, causing the heart to go into a state of ventricular fibrillation. Ventricular fibrillation is a potentially life-threatening arrhythmia in which the heart beats erratically, preventing it from effectively pumping blood throughout the body. It is important to note that not all blows to the chest will result in commotio cordis. The blow must occur during a specific window of vulnerability during the cardiac cycle, which typically occurs within the first 20 milliseconds of the T-wave of the electrocardiogram (ECG) waveform.

Clinical presentation

Commotio cordis presents with sudden collapse, loss of consciousness, and cessation of breathing. The collapse usually occurs immediately after the blow to the chest, and the patient may not show any signs of distress prior to the event. The victim's pulse may be absent or irregular, and their skin may appear pale or blue. It is important to recognize the early signs of commotio cordis and initiate treatment as soon as possible to increase the chances of survival.

Diagnosis

Diagnosis of commotio cordis is based on clinical presentation, and the presence of ventricular fibrillation on an ECG. A chest x-ray and echocardiogram may be done to rule out other possible causes of sudden cardiac arrest.

Treatment

Immediate treatment for commotio cordis includes cardiopulmonary resuscitation (CPR) and defibrillation with an automated external defibrillator (AED). The key to successful treatment is early recognition and intervention. It is important to note that the longer the delay between the onset of ventricular fibrillation and defibrillation, the lower the chances of survival.

Prevention

Prevention is the best way to avoid commotio cordis. Athletes should wear appropriate protective gear, such as chest protectors, during sports activities that may result in blunt chest trauma. Education of coaches, parents, and athletes regarding the importance of protective gear and recognizing the early signs of commotio cordis is also critical in preventing this condition.

Summary

Commotio cordis is a rare but potentially fatal condition caused by blunt force trauma to the chest. It occurs when a blow to the chest is delivered during a specific portion of the cardiac cycle, causing ventricular fibrillation. Early recognition and intervention are crucial for successful treatment, and prevention is the best way to avoid this condition.

References

• Link MS, Maron BJ, et al. "Commotio Cordis and the Epidemiology of Sudden Death in Competitive Lacrosse." Pediatrics. 2001; 108: e62.
• Maron BJ, Estes NA, et al. "Commotio Cordis: Strategies for Resuscitation." Pediatrics. 2002; 109: 873-877.
• Maron BJ, Gohman TE, et al. "Commotio Cordis: A Review." Journal of the American College of Cardiology. 1995; 25: 1224-1229.
• Madias JE. "Commotio Cordis." New England Journal of Medicine. 1999; 340: 1462-1463.

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