Commotio cordis: Difference between revisions
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**Baseball is most common culprit | **Baseball is most common culprit | ||
*Autopsy usually shows normal cardiac anatomy with no evidence of damage to heart or other intrathoracic structures<ref name="Ngai">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.</ref> | *Autopsy usually shows normal cardiac anatomy with no evidence of damage to heart or other intrathoracic structures<ref name="Ngai">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.</ref> | ||
{{Background BCI}} | |||
===Pathophysiology<ref name="Ngai" />=== | ===Pathophysiology<ref name="Ngai" />=== | ||
*Primary electrical event resulting in induction of | *Primary electrical event resulting in induction of [[Ventricular Fibrillation]] | ||
*Likely due to blow occurring 10-30ms before peak of T wave | *Likely due to blow occurring 10-30ms before peak of T wave, although this theory is disputed<ref name="Yousef" /> | ||
*Strike directly over cardiac silhouette ↑ risk of developing commotio cordis | *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. | *Younger patients more at risk - compliant chest wall allows transmission of more energy to the heart. | ||
==Clinical Features== | ==Clinical Features== | ||
*Cardiac arrest (usually ventricular fibrillation) | *[[Cardiac arrest]] (usually [[ventricular fibrillation]]) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Thoracic trauma DDX}} | {{Thoracic trauma DDX}} | ||
== | ==Evaluation== | ||
*Clinical | *Clinical | ||
| Line 29: | Line 31: | ||
==See Also== | ==See Also== | ||
[[Thoracic | *[[Blunt cardiac injury]] | ||
*[[Thoracic trauma]] | |||
==References== | ==References== | ||
<References/> | <References/> | ||
[[Category: | [[Category:Cardiology]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Latest revision as of 20:56, 17 August 2019
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]
Blunt cardiac injury
- A spectrum of disease due to blunt trauma to the chest wall
- Ranges from cardiac contusion to infarction to cardiac rupture and death.[3]
- Commotio cordis is sudden cardiac arrest resulting from blunt chest trauma, in absence of underlying cardiac disease[1]
- Up to 20% of all MVC deaths are due to blunt cardiac injury
Pathophysiology[2]
- Primary electrical event resulting in induction of Ventricular Fibrillation
- 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
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
- Clinical
Management
- Standard adult or pediatric cardiac arrest management
- Prognosis is poor, with only 16% survival rate[2]
Disposition
- Admit to ICU if ROSC is achieved
- See Post Cardiac Arrest
See Also
References
- ↑ 1.0 1.1 1.2 1.3 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.
- ↑ 2.0 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.
- ↑ El-Menyar A, Al Thani H, Zarour A, Latifi R. Understanding traumatic blunt cardiac injury. Ann Card Anaesth. 2012 Oct-Dec;15(4):287-95. doi: 10.4103/0971-9784.101875.