Commotio cordis: Difference between revisions
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==Background== | ==Background== | ||
*Sudden cardiac arrest resulting from blunt chest trauma in absence of underlying cardiac disease<ref name="Yousef">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.</ref> | |||
*50% of cases due to competitive sports<ref name="Yousef" /> | |||
**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> | |||
===Pathophysiology<ref name="Ngai" />=== | |||
*Primary electrical event resulting in induction of Vfib | *Primary electrical event resulting in induction of Vfib | ||
* | *Likely due to blow occurring 10-30ms before peak of T wave | ||
** | *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== | ==Clinical Features== | ||
*Cardiac arrest | *Cardiac arrest (usually ventricular fibrillation) | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Management== | ==Management== | ||
*Standard [[Adult Pulseless Arrest|adult]] or [[Pediatric Pulseless Arrest|pediatric]] cardiac arrest management | *Standard [[Adult Pulseless Arrest|adult]] or [[Pediatric Pulseless Arrest|pediatric]] cardiac arrest management | ||
*Prognosis is poor, with only 16% survival rate<ref name="Ngai" /> | |||
==Disposition== | ==Disposition== | ||
Revision as of 10:47, 24 July 2015
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
- 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
Diagnosis
- 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 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.