Commotio cordis

Sudden death from ventricular fibrillation triggered by blunt, nonpenetrating blow to the chest without damage to the heart, ribs, or sternum and in the absence of underlying cardiovascular disease.

An important cause of sudden cardiac death.

Occurs primarily in children, adolescents and young adults participating in recreational and sports activities and rarely occurs with routine activities.

Incidence unknown, but it is among the most frequent cardiovascular causes of sudden death in young individuals after hypertrophic cardiomyopathy and congenital anomalies of coronary arteries.

Most information about this entity comes from the National Commotio Cordis Registry in Minneapolis: Predilection for children and adolescents, with 26% involving children under the age of 10 years and only 9% are over the age of 25 years. Most affected are males (95%), and caucasian (78%).

Most injuries from chest blows from blunt contact or from projectiles.

While immediate cardiovascular collapse is typical, 20% of victims are physically active for a few seconds after the blow.

About 50% of cases reported in young athletes between ages 11-20 participating in organized sports.

May occur from physical contact among competitors.

About 25% of such events occur in recreational sports, with a disproportionate number of cases among children younger than 10 years, with family or friends responsible for the blow.

About 25% of cases are not associated with sporting events.

Usually fatal events.

About 25% of patients treated with cardiopulmonary resuscitation or defibrillation can survive.

The National Commotio Cordis Registry in Minneapolis data suggest survival events of such is increasing, up to 35% over the last decade.

Ventricular fibrillation felt to be the primary associated arrhythmia.

When mechanical energy from a chest blow confined to a small area of the precordium alters electrical stability of the myocardium and results in ventricular fibrillation.

The blow must be over the heart to cause sudden death.

The blow must occur during the vulnerable electrical period 10-20 msec on the upstroke of the T wave, the period when dispersion of repolarization is greatest and can provoke ventricular fibrillation.

Impact energy encompasses a wide range of velocities, and projectile sizes, shapes and mass.

The thin, compliant chest of the young may be responsible for the higher incidence in young individuals.

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