Commotio cordis

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Background

  • Sudden cardiac arrest resulting from blunt chest trauma in absence of underlying cardiac disease[1]
  • 50% of cases due to competitive sports[1]
    • Baseball is most common culprit
  • Autopsy usually shows normal cardiac anatomy with no evidence of damage to heart or other intrathoracic structures[2]

Pathophysiology[2]

  • Primary electrical event resulting in induction of Vfib
  • Likely due to blow occurring 10-30ms before peak of T wave, although this theory is disputed[1]
  • Strike directly over cardiac silhouette ↑ risk of developing commotio cordis
  • Younger patients more at risk - compliant chest wall allows transmission of more energy to the heart.

Clinical Features

  • Cardiac arrest (usually ventricular fibrillation)

Differential Diagnosis

Thoracic Trauma

Evaluation

  • Clinical

Management

  • Standard adult or pediatric cardiac arrest management
  • Prognosis is poor, with only 16% survival rate[2]

Disposition

See Also

Thoracic Trauma

References

  1. 1.0 1.1 1.2 Yousef R, Carr JA. Blunt cardiac trauma: a review of the current knowledge and management. Ann Thorac Surg. 2014 Sep;98(3):1134-40. doi: 10.1016/j.athoracsur.2014.04.043.
  2. 2.0 2.1 2.2 Ngai KY, Chan HY, Ng F. A patient with commotio cordis successfully resuscitated by bystander cardiopulmonary resuscitation and automated external defibrillator. Hong Kong Med J. 2010 Oct;16(5):403-5.