Ever heard of Commotio Cordis?

 

It is from the result of a blow to the chest at a critical time at a precise millisecond between heart contractions that throws the heart into lethal ventricular fibrillation(VF).  It is not of the force of the blow and causes no identifiable structural injury to the ribs, sternum or to the heart itself.

 

The actual number every year is really unknown since many are misdiagnosed. One estimate was 62/yr.  It occurs during several different sports and activities.  One list reported having 53=Baseball, 14=Softball, 10=Hockey pucks, 8=Fists and boxing, 5=Knee or foot, 5=Elbows, 5=Lacross balls, 5=Parent Disciplining Child, 4=Shoulder, 2=Cricket balls, 2=Football helmet.  As you can see most are from baseball and even very slow speed balls can cause it.  The chest protectors do not prevent this.  Survival after a commotio cordis event has increased over the years from when there was 5% survival.  Survival has usually been associated with effective and timely CPR efforts and defibrillation that occur within 3 minutes of the collapse.  Current estimates are 70-90% survival.   Although efforts at resuscitation occur frequently, the onset of CPR is often delayed because observers underestimate the severity of the trauma or condition. The survival rate is only 5% or less in cases in which resuscitative efforts were delayed longer than 3 minutes.

 

The most common cause of sudden death in athletes is hypertrophic cardiomyopathy.  It is a heart condition of very thick wall muscle of the heart.  Again there are not accurate estimates but it is uncommon … one in 5,000??  Many have no symptoms before cardiac arrest but some have irregular heart beats or passing out while exercising/running.  The doctor’s physical exam can pick up maybe around 10% who are likely to have this condition.  An ECG picks up around 90%. (More accurate than us.) Europe has been screening teenagers for many years and the incidence has greatly decreased there.  America does not recommend screening them here because of cost and the rareness of the condition.  Cook Children’s cardiology performs the sports ECG for $25.  That is like going out to eat now days. So I ask the parents to get the sport’s ECG done around 12 years old. 

 

So for both of these conditions it is critical to act IMMEDIATELY with CPR and AED shock.  You can also first slap the chest hard with the palm of your hand and deliver a shock that can restart the heart rhythm.  Can’t hurt to do that as you start CPR and run for the AED.  This is rare!  You probably won’t need this information.  But many new parents learn CPR just in case. Please don’t worry about your child but it is nice to know this information. 

 

Here are some examples:

 

commotio cordis

https://www.youtube.com/watch?v=sff0_njY_lQ

Saved by AED

https://www.youtube.com/watch?v=dgYeUyIOzhk&t=6s

Implanted defibrillator saves soccer player.

https://www.youtube.com/watch?v=v8fwQCygr4E

 

Roger Knapp MD