Commotio cordis

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]

Blunt cardiac injury
Spectrum of 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[1]
    • Up to 20% of all MVC deaths are due to blunt cardiac injury

Pathophysiology[2]
  • Primary electrical event resulting in induction of Ventricular Fibrillation
  • Likely due to blow occurring 10-30ms before peak of T wave, although this theory is disputed[1]
  • 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

Differential Diagnosis

Thoracic Trauma

Evaluation
  • Clinical

Management
  • Standard adult or pediatric cardiac arrest management
  • Prognosis is poor, with only 16% survival rate[2]

Disposition

See Also

References
  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. 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.
  3. 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.
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