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]
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
- Cardiac arrest (usually ventricular fibrillation)
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
- Clinical
Management
- Standard adult or pediatric cardiac arrest management
- Prognosis is poor, with only 16% survival rate[2]
Disposition
- Admit to ICU if ROSC is achieved
- See Post Cardiac Arrest
See Also
References
- ↑ 1.0 1.1 1.2 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.
- ↑ 2.0 2.1 2.2 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.