Commotio cordis occurs after a blunt, non-penetrating blow to the precordial area of the chest wall that results in the induction of an often fatal ventricular fibrillation in a heart that does not have a preexisting structural or electrophysiological cardiovascular disease (Yabek, 2011). The blow is often perceived to be irrelevant, yet can cause a debilitating injury or even death. Death may be sudden or after a brief period of lucidity with purposeful movement prior to collapse (Yabek, 2011). The emphasis of commotio cordis in this paper will be on it occurring in sports, as it is most commonly happens there. It has also been known to occur when impact of the chest occurs, such as a steering wheel during a motor vehicle accident, playful boxing, bodily contacts, parental discipline, and even a closed fist punch to the chest (Maron, Goham, Kyle, Estes III, & Link, 2002).
The prevalence of commotion cordis aids in the importance of this paper. Recently, the Minneapolis Heart Institute Foundation stated commotio cordis is one of the leading causes of sudden death in young athletes, only to be exceeded by hypertrophic cardiomyopathy and congential coronary artery abnormalities (Yabek, 2011). Over 250 instances have been reported to the US Commotio Cordis Registry since, there is most likely and underestimation of its true incidence since commotio cordis still continues to go unrecognized in many instances and therefore is underreported (Yabek, 2011).
In recognizing the risks of commotio cordis, it is vital to discuss who commotio cordis predominantly occurs in. Commotio cordis is most often seen in young male athletes, in whom a sudden, blunt, nonpenetrating and innocent-appearing trauma to the anterior chest wall which results in cardiac arrest and sudden death from ventricular fibrillation (Yabek, 2011). It is most often seen in baseball, but may also be seen hockey, lacrosse, and karate (Yabek, 2011).
For commotio cordis to occur, a cluster of conditions must be instantaneously met. These conditions include: force, timing, and location (Valani, Mikrogianakis & Goldman, 2004). The chest wall blow must occur directly over the anatomical position of the heart. Blows directly over the center of the heart are have an increase in lethality compared to those over the periphery of the heart (Link, Maron, VanderBrink, Takuchi, Pandian, Wang & Estes III, 2001). The impact is likely to be more fatal in the young in comparison to adults; this is thought to be one of the most important components. It is stated by Rahim Valani et al. in an article on commotio cordis in Pediatrics for the Canadian Journal of Emergency Medicine, “a compliant chest wall, as seen in most children, increases the susceptibility to cardiac concussion.” In other words, the anatomy of a child’s chest wall and rib offers less protection thoracic organs compared to as they grow older into a fully developed adult (Van Amerongen, Rosen, Winnik & Horwitz, 1997).