Commotio Cordis
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Commotio Cordis: Did Damar Hamlin Suffer a Concussion in His Heart? .
One may wonder why most hits to the chest in contact sports do not cause commotio cordis, and the answer again lies in the heart’s electrical system. There is a very narrow window of time, 15 thousandths of a second, during the cardiac cycle when a traumatic impact will cause this deadly arrhythmia. More specifically, the timing of the trauma must occur during a very narrow window of time during the upstroke of the T wave (repolarization of T-wave on the electrocardiogram) (approximately 10 – 20 msec in duration). The timing of the impact to the chest must occur when the dispersion of the electrical repolarization of the heart muscle cells is the greatest. In other words, commotio cordis requires…
Resources
The National Commotio Cordis Registry
Sudden cardiac death in young athletes is usually due to a variety of unsuspected congenital heart malformations. Less well recognized are those athletic field catastrophes in which cardiac arrest is produced by direct, blunt blows delivered directly to the chest by high-velocity missiles and objects such as baseballs or hockey pucks during sports activities, in the absence of identifiable morphologic injury to the sternum, ribs or heart itself (commotio cordis).
How an NFL hit could stop a heart
It’s rare, but a direct hit can cause cardiac arrest.
Case of Commotio Cordis
Ventricular fibrillation and sudden death triggered by a blunt, non penetrating, and often innocent appearing unintentional blow to the chest without damage to the ribs, sternum, or heart (and in the absence of underlying cardiovascular disease) constitute an event know as commotio cordis, which translates from the Latin as agitation of the heart.
Commotio Cordis
There are more than 190 reported cases of commotio cordis in the United States. Forty-seven percent of reported cases occurred during athletic participation. Commotio cordis is the second-most common cause of sudden cardiac death in athletes. Occurrence of commotio cordis is related to time of impact during the cardiac cycle, direct impact over the heart, the hardness and speed of the projectile, and the ineffectiveness of chest barriers.
Did Damar Hamlin experience commotio cordis? What to know about the rare phenomenon
While Hamlin's team and family have yet to confirm exactly what happened, many of the doctors following his case online have narrowed it down to one likely cause: commotio cordis (kuh-MOH-dee-oh KOR-dis). That's when a blunt blow to the chest, delivered at a specific point in the cardiac cycle, induces a dangerous, life-threatening heart arrhythmia or cardiac arrest.
Commotio Cordis: Did Damar Hamlin Suffer a Concussion in His Heart? .
Given how infrequent commotio cordis is, his case does fall under the category of “freak accident” (but not unheard of) rather than a new danger to football players.
Korey Stringer Institute
Commotio Cordis refers to the sudden arrhythmic death caused by a low/mild chest wall impact. Commotio Cordis is seen mostly in athletes between the ages of 8 and 18 who are partaking in sports with projectiles such as baseballs, hockey pucks, or lacrosse balls. These projectiles can strike the athletes in the middle of the chest with a low impact but enough to cause the heart to enter an arrhythmia. Martial arts is a sport in which a strike of a hand can also cause the heart to change it’s rhythm. Without immediate CPR and defibrillation the prognosis of commotio cordis is not very good.
SportsMedToday.com
Use of age-appropriate, soft baseballs up to age 13 is recommended. Chest protectors have not yet been shown to be effective in reducing risk. The most important strategy is to prepare for sudden cardiac arrest by training coaches and staff in recognizing commotio cordis and sudden cardiac arrest.
StatPearls
Commotio cordis is ventricular fibrillation precipitated by blunt trauma to the heart. Although it is infrequent, it is an important cause of sudden death in young athletes.
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