Commotio cordis is a rare but serious condition in which a sudden, blunt impact to the chest causes a disruption in the normal rhythm of the heart, leading to cardiac arrest. It is most commonly seen in young athletes participating in sports that involve a high risk of chest trauma, such as baseball, hockey, and lacrosse. The primary cause of commotio cordis is a direct blow to the chest that strikes the heart at a vulnerable point in its electrical cycle.
Commotio cordis occurs when a blunt impact to the chest strikes the heart at a specific point in the electrical cycle, known as the “vulnerable period.” This is the point in the cycle when the heart’s electrical activity is in a state of relative refractoriness, making it more susceptible to electrical disruption.
When the impact occurs during this vulnerable period, it can cause a disturbance in the normal electrical activity of the heart, leading to a cardiac arrest. This disturbance can manifest as an abnormal heart rhythm, such as ventricular fibrillation or tachycardia. These rhythms are life-threatening and require immediate treatment with CPR and defibrillation to restore normal heart rhythm.
It is believed that the impact causes a temporary functional or structural alteration of the myocardium which leads to the disturbance of the normal cardiac electrical activity.
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Symptoms of commotio cordis include sudden collapse, loss of consciousness, and no pulse or breathing. Treatment typically includes cardiopulmonary resuscitation (CPR) and defibrillation to restore a normal heart rhythm. Long-term outcome varies and depends on the duration of cardiac arrest and the quality of CPR and defibrillation received.
Prevention of commotio cordis includes the use of chest protectors and other protective gear, as well as education on the proper technique for chest impact in sports. The future effect of commotio cordis is unknown, but research continues to be done to understand the underlying mechanisms of the condition and to develop better treatments.
Reference:
- “Commotio Cordis” (https://www.heart.org/en/health-topics/cardiac-arrest/causes-of-cardiac-arrest/commotio-cordis) American Heart Association.
- “Commotio Cordis: A Review” (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237566/) Journal of Cardiac Arrest and Acute Cardiac Care.