What is commotio cordis ?
In its translation from Latin to Spanish, commotio cordis means: “commotion or agitation of the heart”. According to the American Heart Association, it is an “unusual event, but it remains a major cause of mortality in youth sports , as well as in many other circumstances.”
Commotio cordis is the appearance of a set of arrhythmias that modify the normal heart rhythm of the individual and that is produced by a blow to the chest, in the region of the heart. These arrhythmias can lead to cardiac arrest and sudden death of the person because the mechanical energy generated by the blow alters the electrical stability of the myocardium.
What happens if you hit yourself in the heart?
Fortunately, in most cases nothing will happen. We can fall to the ground, be breathless for a moment or somewhat dazed. But for commotio cordis and sudden death to occur, a series of difficult circumstances must come together, but sometimes it happens. That is why it is interesting to know about this phenomenon, because despite the fact that it occurs infrequently within the population, it has a high degree of fatal outcome, almost always causing the death of the person .
We could say that you have to be in the right place at the right time. In addition, the blow to the chest has to be received in the area where our left ventricle is, it has to occur perpendicular to the chest and at the right time. The moment is a window of the cardiac cycle in which the heart is relaxing to generate a new impulse : this period represents only 1% of the cardiac cycle and occupies 20 milliseconds of the cycle.
The speed also has an influence : it has to be enough to generate a change in our cardiac cycle, but it must not be too high so as not to generate cardiac injury or structural damage to the heart, sternum, ribs, etc. The studies speak of approximately 65 km/h, but without exceeding 80 because direct damage is already produced there, and the characteristic of the commotio cordis is that there is no structural damage.
Don’t be fooled by the size of the ball, small balls can carry a higher risk of commotio cordis , probably because the impact is concentrated on a smaller surface area.
Who is most at risk for this type of sudden death?
According to the US Commotio Cordis Registry : “200 athletes have died from a stroke to the heart since 1995, the median age was 14.7 years, and 96% were male athletes .” Children and adolescents are thought to be more vulnerable due to their characteristic thin chest wall and poorly developed intercostal musculature .
According to the work of Medrano (2019), 50% of registered cases of sudden cardiac death due to commotio cordis occur during sports practice. Specifically in baseball, softball, ice hockey, lacrosse or even during cricket. They are sports in which projectiles such as balls and discs are usually involved .
But we have to keep in mind that this is not only caused by a ball or a ball. Other sports involving physical impact between players such as rugby, American football, soccer and karate have also been described in the statistics. In these cases, the blows caused by the feet, knees, head and objects such as helmets are the cause of the concussion of the heart .
Fights and other non-sports activities also cause cardiac concussion
The other 50% of the cases of sudden deaths due to commotio cordis occur during the development of apparently non-dangerous activities such as the practice of recreational sports, recreational activities and family gatherings.
Incredible cases of sudden death from chest trauma are collected in an article in The New England Journal of Medicine . Some of these cases involve animals, for example a head butt from a 23kg dog and a kick from a horse. Cases have also been described from being hit with a snowball, from the recoil of a gun butt while a child was hunting, and from a bouncing playground swing.
The most surprising case is that of a young man who received a blow to the chest to stop his hiccups. You also have to take into account the fights that have even led to criminal penalties for manslaughter and murder.
How can we avoid sudden death from a blow to the chest?
Maron states that ” commotio cordis survival has increased, likely due to faster response times and access to automated external defibrillators that can be used by the population, as well as increased public awareness of this condition.”
Fortunately, the most recently reported survival rates exceed 50%.
And here is the key: prevention and early care that are achieved by recognizing the situation. The American Heart Association provides us with the following recommendations in its scientific statement on the subject published in 2015:
- Personnel in areas where sports practices take place should be trained to ensure successful resuscitation of victims with commotio cordis . The fact must be recognized quickly: after the trauma , the person is not responding or breathing . You have to quickly call the emergency services, perform cardiopulmonary resuscitation and early defibrillation .
- It is reasonable to use age-appropriate safety baseballs to reduce the risk of injury and commotio cordis .
The National Operating Committee for Sports Equipment Standards, NOCSAE for its acronym in English, is the body that regulates the protective equipment of helmets, vests and other elements used in sports in the US. This organization, and the National Association of Athletic Trainers of the USA, recommend the use of chest protectors specific for the sport during training and games, which are of quality and fit correctly.
Additionally, both associations emphasize further research in this area of protectors because information is limited and 37% of reported cases occurred with chest protectors in place .
References:
Link et al. 2015. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task force 13: Commotio Cordis: A scientific statement from the American heart association and American college of cardiology. Journal of the American College of Cardiology. DOI: http://dx.doi.org/10.1016/j.jacc.2015.09.045
Maron et al. 2010. The shaking of the heart. The New England Journal of Medicine. DOI: http://dx.doi.org/10.1056/NEJMra0910111
Maron et al. 2013. Increasing survival rate from heart disturbance. Heart Rhythm. DOI: http://dx.doi.org/10.1016/j.hrthm.2012.10.034
Medrano et al. 2021. The heart’s shaking: What causes sudden cardiac relief from the deportiva’s restraints? Revista CientÃfica WISDOM. Retrieved from: https://publiccionescd.uleam.edu.ec/index.php/wiss/article/view/199
Tainter et al. 2021. Heart-shaking Pearls stands still. Available at https://europepmc.org/article/NBK/nbk526014#_article-19761_s4_
