Commotio cordis

Background

• Primary electrical event resulting in induction of Vfib
  • Due to blow occurring 10-30ms before peak of T wave
  • Often results from innocent-appearing chest wall blow
    • Usually insufficient to cause damage to ribs, sternum, or heart
    • Autopsy results usually show normal cardiac anatomy
• Second most common cause of death in young athletes after HOCM
  • Seen in sports where hard projectiles are used, e.g. baseball, hockey and lacrosse

Clinical Features

• Cardiac arrest, usually ventricular fibrillation.

Differential Diagnosis

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Diagnosis

• Clinical

Management

• Standard adult or pediatric cardiac arrest management

Disposition

• Admit to ICU if ROSC is achieved
• See Post Cardiac Arrest

See Also

Thoracic Trauma