Commotio Cordis

agitation of the heart

What is Commotio Cordis?

Commotio cordis is a phenomenon in which a sudden blunt impact to the chest causes sudden death in the absence of cardiac damage. It is the same thing as Cardiac Contusion. The fatality rate for Commotio Cordis is about 65%. It can sometimes, but not always, be reversed by defibrillation.

Who does it affect?

Primarily, Commotio Cordis affects young individuals, the mean age being 15. There have been very few cases where the victim has been over the age of 20. Commotio Cordis is seen mostly in athletics who are partaking in a sport with projectiles such as a baseball. These projectiles (or a hand, like in martial arts) will strike the center of the chest and cause the heart to enter a arrhythmia.

COMMOTIO CORDIS COULD BE MISTAKEN FOR SOMETHING ELSE

Commotio cordis shares a similar presention to:


  • Cardiac Arrest
  • Pulmonary Conditions
  • Hypertrophic Cardiomyopathy
  • Concussion
  • Heat Syncope

SIGNS AND SYMPTOMS

  • Look for an athlete who was hit in the chest by an object such as a baseball, baseball bat, or lacrosse ball.
  • There should be no apparent trauma.
  • The athlete will typically stumble forward for a few seconds, which is followed by unconsciousness, no breathing, and no pulse.
  • An AED will indicate the athlete is in ventricular fibrillation.

TREATMENT FOR THOSE IMPACTED BY COMMOTIO CORDIS

Use an AED, which is a portable device that checks the heart rhythm and can send an electric shock to the heart to try to restore a normal rhythm. For every 1 minute delay in getting shocked by the AED, there is a 10% decline in survival rate.


Using an AED is the best practice and gives the athlete the greatest chance of survival.


Continue to use the AED and CPR method until EMS arrives and takes over.

PREVENTION

  • For any kind of sport, there should be an athletic trainer present.
  • Teach athletes how to avoid being hit directly in the chest.
  • Use safety balls.
  • Avoid strength disparities among participants and coaches.
  • Make sure to educate coaches, parents, and athletes how to perform CPR and use an AED.
  • Make sure everybody knows the signs of Commotio Cordis.

WHEN CAN THE INDIVIDUAL RETURN TO ACTIVITY?

  • Before returning, the athlete should have a cardiac evaluation including ECG by the athlete’s physician. (Physician clearance is necessary before returning to practice)
  • The athletic trainer should use clinical judgement for the athlete to return to playing, and should carefully watch the athlete to ensure a cardiac episode does not occur.
  • Adjust practice by adding personal protection such as chest padding or switching to safety balls to decrease the chance of another incident.

RESOURCES

  • "Commotio Cordis." Commotio Cordis. N.p., n.d. Web. 18 Feb. 2016.
  • "UConn Logo University of Connecticut UC Title Fallback." Korey Stringer Institute. N.p., n.d. Web. 18 Feb. 2016.
  • "What Is an Automated External Defibrillator?" - NHLBI, NIH. N.p., n.d. Web. 18 Feb. 2016.
  • Wikipedia. Wikimedia Foundation, n.d. Web. 18 Feb. 2016.
  • "What Is an Automated External Defibrillator?" - NHLBI, NIH. N.p., n.d. Web. 18 Feb. 2016.