Commotio cordis: Difference between revisions
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==Background== | ==Background== | ||
* | *Sudden [[cardiac arrest]] from blunt, non-penetrating chest wall impact in the absence of underlying cardiac disease or structural damage<ref>Menezes RG, et al. Commotio cordis: A review. Med Sci Law. 2017 Jul;57(3):146-151. PMID 28587536</ref> | ||
** | *50% of cases occur during competitive sports (baseball is most common) | ||
** | *Most commonly affects young males (median age 14)<ref>Lee RN, et al. Commotio Cordis in Non-Sport-Related Events: A Systematic Review. JACC Clin Electrophysiol. 2023 Aug;9(8 Pt 1):1321-1329. PMID 37558288</ref> | ||
*** | *Autopsy shows structurally normal heart with no myocardial contusion, rib fracture, or other thoracic injury | ||
* | |||
{{Background BCI}} | |||
===Pathophysiology=== | |||
*Primary electrical event: blow to precordium during the vulnerable period of repolarization (10-30 ms before T-wave peak) triggers [[ventricular fibrillation]] | |||
*Risk factors for commotio cordis: | |||
**Impact directly over the cardiac silhouette | |||
**Young, compliant chest wall (transmits more energy) | |||
**Velocity of projectile 30-50 mph (neither too slow nor too fast) | |||
**Small, hard projectile (baseball, hockey puck, lacrosse ball) | |||
==Clinical Features== | |||
*Witnessed collapse immediately after chest wall impact | |||
*[[Cardiac arrest]] — usually [[ventricular fibrillation]] | |||
*No external signs of significant chest wall injury | |||
==Differential Diagnosis== | |||
{{Thoracic trauma DDX}} | |||
==Evaluation== | |||
*Clinical diagnosis based on witnessed event and mechanism | |||
*Post-resuscitation workup if ROSC achieved: | |||
**[[ECG]]: may show ST changes or arrhythmias | |||
**Troponin (to evaluate for myocardial injury) | |||
**[[Echocardiography]]: should be structurally normal (distinguishes from [[blunt cardiac injury]]) | |||
**CT chest to rule out other traumatic injuries | |||
==Management== | |||
*Immediate [[CPR]] and early defibrillation — standard [[Adult Pulseless Arrest|ACLS]] or [[Pediatric Pulseless Arrest|PALS]] cardiac arrest management | |||
*'''Early defibrillation is key:''' survival rates improve significantly with prompt AED use | |||
*Overall survival ~25% (improving with increased bystander CPR and AED availability) | |||
==Disposition== | |||
*Admit to ICU if ROSC achieved | |||
*Post-arrest care per [[Post cardiac arrest]] protocol | |||
*Cardiology consult for monitoring and risk stratification | |||
*Consider ICD discussion if recurrent arrhythmias post-resuscitation | |||
==Prevention== | |||
*Chest protectors (limited efficacy — cannot fully prevent commotio cordis) | |||
*Safety baseballs (softer core) reduce risk | |||
*AED availability at all youth sporting events | |||
==See Also== | ==See Also== | ||
[[Thoracic | *[[Blunt cardiac injury]] | ||
*[[Thoracic trauma]] | |||
*[[Post cardiac arrest]] | |||
*[[Ventricular fibrillation]] | |||
== | ==References== | ||
<references/> | |||
[[Category: | [[Category:Cardiology]] | ||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Latest revision as of 10:59, 22 March 2026
Background
- Sudden cardiac arrest from blunt, non-penetrating chest wall impact in the absence of underlying cardiac disease or structural damage[1]
- 50% of cases occur during competitive sports (baseball is most common)
- Most commonly affects young males (median age 14)[2]
- Autopsy shows structurally normal heart with no myocardial contusion, rib fracture, or other thoracic injury
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[4]
- Up to 20% of all MVC deaths are due to blunt cardiac injury
Pathophysiology
- Primary electrical event: blow to precordium during the vulnerable period of repolarization (10-30 ms before T-wave peak) triggers ventricular fibrillation
- Risk factors for commotio cordis:
- Impact directly over the cardiac silhouette
- Young, compliant chest wall (transmits more energy)
- Velocity of projectile 30-50 mph (neither too slow nor too fast)
- Small, hard projectile (baseball, hockey puck, lacrosse ball)
Clinical Features
- Witnessed collapse immediately after chest wall impact
- Cardiac arrest — usually ventricular fibrillation
- No external signs of significant chest wall injury
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
- Clinical diagnosis based on witnessed event and mechanism
- Post-resuscitation workup if ROSC achieved:
- ECG: may show ST changes or arrhythmias
- Troponin (to evaluate for myocardial injury)
- Echocardiography: should be structurally normal (distinguishes from blunt cardiac injury)
- CT chest to rule out other traumatic injuries
Management
- Immediate CPR and early defibrillation — standard ACLS or PALS cardiac arrest management
- Early defibrillation is key: survival rates improve significantly with prompt AED use
- Overall survival ~25% (improving with increased bystander CPR and AED availability)
Disposition
- Admit to ICU if ROSC achieved
- Post-arrest care per Post cardiac arrest protocol
- Cardiology consult for monitoring and risk stratification
- Consider ICD discussion if recurrent arrhythmias post-resuscitation
Prevention
- Chest protectors (limited efficacy — cannot fully prevent commotio cordis)
- Safety baseballs (softer core) reduce risk
- AED availability at all youth sporting events
See Also
References
- ↑ Menezes RG, et al. Commotio cordis: A review. Med Sci Law. 2017 Jul;57(3):146-151. PMID 28587536
- ↑ Lee RN, et al. Commotio Cordis in Non-Sport-Related Events: A Systematic Review. JACC Clin Electrophysiol. 2023 Aug;9(8 Pt 1):1321-1329. PMID 37558288
- ↑ 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.
- ↑ 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.