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Commotio Cordis

An Underappreciated Cause of Sudden Death in Athletes

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Abstract

Over the last few years, the recognised cardiovascular risks of sporting activities have been extended to include cardiac arrest resulting from low-energy precordial chest impact produced by projectiles (e.g. baseball) or bodily contact, in the young, healthy and active athlete [also known as commotio cordis (CC)]. However, case reports of CC in European medical literature can be traced back for at least 130 years.

CC accounts for a small, but important, subset of sudden death during sporting activities. It is a devastating electrophysiological event in the young athlete, and one which has generated considerable concern, both in the medical profession as well as in the public.

The mechanism of sudden death appears to be caused by ventricular fibrillation, which occurs when the chest impact is delivered within a narrow, electrically vulnerable portion of the cardiac cycle, that is, during repolarisation, just before the peak of the T wave. Resuscitation of these victims is possible with prompt cardiopulmonary resuscitation and defibrillation. Preventive measures, such as the use of age-appropriate safety baseballs and suitably designed chest wall protection, may reduce the risk of sudden death and, thus, make the athletic field a safer place for young athletes.

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References

  1. Rasdorff EJ, Prodinger RJ. Sudden cardiac death in the athlete. Emerg Med Clin of North Am 1998 May; 16 (2): 281–93

    Article  Google Scholar 

  2. Maron BJ. Sudden death in young athletes: lessons from the Hank Gathers affair. N Engl J Med 1993; 329 (1): 55–7

    Article  PubMed  CAS  Google Scholar 

  3. Maron BJ, Epstein SE, Roberts WC. Causes of sudden death in competitive athletes. J Am Coll Cardiol 1986 Jan; 7 (1): 204–14

    Article  CAS  Google Scholar 

  4. Basso C, Corrado D, Thiene G. Cardiovascular causes of sudden death in young individuals including athletes. Cardiol Rev 1999 May–Jun; 7 (3): 127–35

    Article  PubMed  CAS  Google Scholar 

  5. van Camp SP, Bloor CM, Mueller PO, et al. Non-traumatic sports death in high school and college athletes. Med Sci Sports Exerc 1995; 27: 641–7

    PubMed  Google Scholar 

  6. Maron BJ. Cardiovascular risks to young people on the athletic field. Ann Intern Med 1998 Sep; 129 (5): 379–86

    PubMed  CAS  Google Scholar 

  7. Virmani R, Burke AP, Farb A, et al. Causes of sudden death in young and middle-aged competitive athletes. Cardiol Clin 1997 Aug; 15 (3): 439–66

    Article  PubMed  CAS  Google Scholar 

  8. Maron BJ, Link MS, Wang PJ, et al. Clinical profile of commotio cordis: an under-appreciated cause of sudden death in the young during sports and other activities. J Cardiovasc Electrophys 1999 Jan; 10: 114–20

    Article  CAS  Google Scholar 

  9. Maron BJ, Poliac LC, Kaplan JA, et al. Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. N Engl J Med 1995 Aug 10; 333 (6): 337–42

    Article  PubMed  CAS  Google Scholar 

  10. Nelaton A. Element de pathologie chirurgicale. Paris: Librairie Germer Bateliere et Co, 1876

    Google Scholar 

  11. Meola F. La commonzione thoracica. G Int Sci Med 1879; 1: 923–37

    Google Scholar 

  12. Riedinger J. Ueber herzaffectionen nach unfallen. Monatsschr Unfallheilkunde 1894; 1: 351–6

    Google Scholar 

  13. Riedinger J, Kummel H. Die verletzengen und erkrankungen des thorax und seines inhaltes. In: Bergman EV, Bruns PV, editors. Handbuch der praktishen chirurgie. Stuggart: Enke 1903; 1: 373–456

    Google Scholar 

  14. Reinebroth F. Der Einflussder der erschutterungdes brustkorbes auf die gefasse der pleura and lunge und ein entstehungsmodusder traumatischen haemoptoe. Munch Med Wochenschr 1898; 37: 1170–72

    Google Scholar 

  15. Schlomka G, Hinrichs A. Experimentelle untersuchungen uber den einflu stumpfer brustkorbverletzungen auf das elektrokardiogramm. Z Gesamte Exp Med 1932; 81: 43–61

    Article  Google Scholar 

  16. Schlomka G, Schmitz M. Experimentelle untersuchungen uber den einflu stumpfer brustkorbverletzungen auf das elektrokardiogramm (II Mitteilung). Z Gesamte Exp Med 1932; 83: 779–91

    Article  Google Scholar 

  17. Lab MJ. Mechanoelectric feedback in heart: concepts and implications. Cardiovasc Res 1996 Jul; 32 (1): 3–14

    PubMed  CAS  Google Scholar 

  18. Hediger C. Beitrage zur pathologischen anatomie der contusio end commotio cordis. Cardiologia 1944; 8: 1–48

    Article  Google Scholar 

  19. Parmley L, Manion N, Mattingly T. Non-penetrating traumatic injury to the heart. Circulation 1958; 18: 371–93

    Article  PubMed  CAS  Google Scholar 

  20. Golikov AP, Borisenkko AP. Manifestation and pathogenesis of cardiac trauma. Ter Arkh 1976; 48: 88–94

    PubMed  CAS  Google Scholar 

  21. Lindsey D, Froede RC, Steinbronn K. Sudden unexpected death from cardiac concussion (commotio cordis) with unusual legal complications. J Forensic Sci 1979; 24: 752–6

    PubMed  Google Scholar 

  22. Liedtke AJ, Gault JH, Demuth WE. Electrocardiographic and hemodynamic changes following non-penetrating chest trauma in the experimental animal. Am J Physiol 1974; 226: 377–82

    PubMed  CAS  Google Scholar 

  23. Liedtke AJ, Allen RP, Nellis SH. Effects of blunt cardiac trauma on coronary vasomotion, perfusion, myocardial mechanics and metabolism. J Trauma 1980; 20: 777–85

    Article  PubMed  CAS  Google Scholar 

  24. Morikawa M, Hirose K, Mori T, et al. Myocardial contusion caused by baseball. Clin Cardiol 1996 Oct; 19 (10): 831–3

    Article  PubMed  CAS  Google Scholar 

  25. Abrunzo TJ. Commotio cordis: the single most common cause of traumatic death in youth baseball. Am J Dis Child 1991 Nov; 145 (11): 1 279–82

    CAS  Google Scholar 

  26. Futterman LG, Lemberg L. Commotio cordis: sudden cardiac death in athletes. Am J Crit Care 1999 Jul; 8 (40); 270–2

    PubMed  CAS  Google Scholar 

  27. Deady B, Innes G. Sudden death of a hockey player: case report of commotio cordis. J Emerg Med 1999 May–Jun; 17 (30): 459–62

    Article  PubMed  CAS  Google Scholar 

  28. Kaplan JA, Karofsky PS, Volturo GA. Commotio cordis in 2 amateur ice-hockey players despite the use of commercial chest protectors: case reports. J Trauma 1993 Jan; 34 (1); 151–3

    Article  PubMed  CAS  Google Scholar 

  29. Sadler DW. Commotio cordis: sudden death due to chest wall impact in sports [letter]. Heart 1999 Oct; 82: 534

    PubMed  CAS  Google Scholar 

  30. Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes: clinical, demographic and pathological profiles. JAMA 1996; 276: 199–204

    Article  PubMed  CAS  Google Scholar 

  31. Link MS, Wang PJ, Pandian NG, et al. An experimental model of sudden death due to low-energy chest wall impact (commotio cordis). N Engl J Med 1998 Jun 18; 338 (25): 1805–11

    Article  PubMed  CAS  Google Scholar 

  32. Kroell CK, Allen S, Warner CY, et al. Inter-relationship of velocity and chest compression in blunt thoracic impact to swines [Society of Automotive Engineers (SAE) technical paper 861881]. Proceedings of the 30th Stapp Car Crash Conference. Warrendale (PA): Society of Automotive Engineers, 1986: 99

    Google Scholar 

  33. Viano DC, Lau IV. Role of impact velocity and chest compression in thoracic injury. Aviat Space Environ Med 1983; 54: 16–21

    PubMed  CAS  Google Scholar 

  34. Viano DC, Lau IV. A viscous tolerance criterion for soft tissue injury assessment. J Biomech 1988; 21: 387–99

    Article  PubMed  CAS  Google Scholar 

  35. Balser JR. Sodium ‘channelopathies’ and sudden death: must you be so sensitive? Circ Res 1999; 85: 872–4

    Article  PubMed  CAS  Google Scholar 

  36. Noma A. ATP-regulated K+ channels in cardiac muscle. Nature 1983; 305: 147–8

    Article  PubMed  CAS  Google Scholar 

  37. Isomoto S, Kurachi Y. Function, regulation, pharmacology and molecular structure of ATP-sensitive K+ channels in the cardiovascular system. J Cardiovasc Electrophys 1997; 8: (1) 431–46

    Article  CAS  Google Scholar 

  38. Billman GE. Role of ATP-sensitive K+ channels in extracellular K+ accumulation and cardiac arrhythmia during myocardial ischemia. Cardiovasc Res 1994; 28: 762–9

    Article  PubMed  CAS  Google Scholar 

  39. Findlay I. Inhibition of ATP-sensitive K+ channels in cardiac muscle by the sulphonylurea drug, glibenclamide. J Pharmacol Exp Ther 1992; 261: 540–5

    PubMed  CAS  Google Scholar 

  40. Link MS, Wang PJ, Vanderbrink BA, et al. Selective activation of the K+-ATP channel is a mechanism by which sudden death is produced by low-energy chest wall impact (commotio cordis). Circulation 1999; 100: 413–8

    Article  PubMed  CAS  Google Scholar 

  41. Hamlin RL, Burton RR, Leverett SD, et al. The ECG from miniature swines recorded with the Mc Fee-axial Reference Program. J Electrocardiol 1974; 7: 155–62

    Article  PubMed  CAS  Google Scholar 

  42. Kyle SB. Youth Baseball protective equipment project: final report. Washington, DC: Consumer Product Safety Commission, 1996

    Google Scholar 

  43. Janda DH, Viano DC, Andrzejak DV, et al. An analysis of preventive methods for baseball-induced chest impact injuries. Clin J Sports Med 1992; 2: 172–9

    Article  Google Scholar 

  44. Mills JD, Moore GE, Thompson PD. The athlete’s heart. Clin Sports Med 1997 Oct; 16 (4): 725–37

    Article  PubMed  CAS  Google Scholar 

  45. Crown LA, Hawkins W. Commotio cordis: clinical implications of blunt cardiac trauma. AmFam Physician 1997 May; 55 (7): 2467–70

    PubMed  CAS  Google Scholar 

  46. Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular preparticipation screening of competitive athletes. Circulation 1996; 94: 850–6

    Article  PubMed  CAS  Google Scholar 

  47. Maron BJ, Mitchell JH. 26th Bethesda conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. Med Sci Sports Exerc 1994; 26 Suppl.: S223–83

    PubMed  CAS  Google Scholar 

  48. Ewy GA, Ornato JP. 31st Bethesda conference: emergency cardiac care. Task Force 1: Cardiac Arrest. J Am Coll Cardiol 2000 Mar; 35 (4): 832–46

    Article  PubMed  CAS  Google Scholar 

  49. McGrew CA. Insights into the AHA Scientific Statement concerning cardiovascular pre-participation screening of competitive athletes. Med Sci Sports Exerc 1998 Oct; 30 (10 Suppl.): S351–3

    PubMed  CAS  Google Scholar 

  50. Maron BJ, Strasburger JF, Kugler JD, et al. Survival following blunt chest impact-induced cardiac arrest during sports activities in young athletes. Am J Cardiol 1997 Mar; 79 (6): 840–1

    Article  PubMed  CAS  Google Scholar 

  51. Link MS, Ginsburg SH, Wang PJ, et al. Commotio cordis: cardiovascular manifestations of a rare survivor. Chest 1998 Jul; 114 (1): 326–8

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore

    Fatimah Lateef (Senior Registrar)

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  1. Fatimah Lateef
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Correspondence to Fatimah Lateef.

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Lateef, F. Commotio Cordis. Sports Med 30, 301–308 (2000). https://doi.org/10.2165/00007256-200030040-00005

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