Commotio cordis is a rare but significant cause of sudden death, particularly among young individuals, and occurs without pre-existing heart disease. It can happen to athletes during sports or in everyday situations. The intensity of the chest impact causing commotio cordis varies, sometimes being severe or surprisingly mild. Quick identification and response to such events are crucial, as immediate CPR or defibrillation can reverse cardiac arrest. The exact cause of commotio cordis is not fully understood, but it involves a chest blow striking the heart during a specific 20 ms period of the T wave’s upstroke.
A recent article in Heart Rhythm Case Reports discusses the case of an 18-year-old basketball player who suffered from commotio cordis, leading to cardiac arrest, after being hit in the chest.
A new case report published in Heart Rhythm Case Reports, an official journal of the Heart Rhythm Society, published by Elsevier, details the commotio cordis event experienced by a Romanian basketball player that resulted in cardiac arrest. The case is unique because it is validated and documented by an ECG and video evidence of the event. Swift action by onlookers saved his life.
Rising Awareness of Commotio Cordis in Sports
In early January 2023, commotio cordis received substantial visibility and notoriety as the underlying cause of cardiac arrest when Damar Hamlin, a defensive player for the Buffalo Bills, was struck in the chest during a collision with an opponent in a US NFL professional football game. Rapid cardiopulmonary resuscitation (CPR) and defibrillation were lifesaving, with the event witnessed by millions on television in real-time.
In Bucharest, Romania, 60 days later and 5,000 miles away, another commotio cordis event occurred, this time during a youth basketball tournament game witnessed only by families and friends. An 18-year-old basketball player (M.V.) was hit in the chest by an inadvertent light blow from an opponent’s elbow and collapsed during the game, which was filmed and documented. Rapid CPR and one defibrillation shock saved his life.
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Initially, there is a scramble for a loose ball and player M.V. (large white arrow) is struck in the chest by the elbow of an opponent. M.V. stumbles but remains upright for a few seconds just prior to full collapse in cardiac arrest. Credit: Heart Rhythm Case Reports
Global Incidence and Understanding of Commotio Cordis
Commotio cordis events have been reported globally in more than 20 countries, but are extraordinarily rare and virtually always counterintuitive, as in M.V.’s case. In commotio cordis, ventricular fibrillation is precipitated by a blow over the heart and requires a precise timing to a narrow 20 ms window at the upstroke of the T wave.
After the commotio cordis event, M.V. was examined at Lahey Hospital and Medical Center in Burlington, MA, USA, by a team led by Barry J. Maron, MD.
There is a scramble for a loose ball and player M.V. (white arrow) is struck in the chest by the elbow of an opponent. M.V. stumbles but remains upright for a few seconds just prior to full collapse in cardiac arrest. Credit: Heart Rhythm Case Reports
Dr. Maron explains, “There is some skepticism regarding the existence of commotio cordis. Since the case of the Romanian basketball player was recorded and documented, it validates the existence of commotio cordis. It is a real phenomenon, and it occurs in real people in sports and in daily living. It is important to raise awareness of this condition, which is reversible with prompt intervention, as this case demonstrates.”
Health and Recovery Post-Commotio Cordis
Prior to the event, M.V. was completely healthy without cardiovascular complaints; there is no family history of cardiovascular diseaseCardiovascular disease refers to a group of conditions that affect the heart and blood vessels, such as coronary artery disease, heart failure, arrhythmias, and stroke. It is caused by a variety of factors, including lifestyle choices (such as smoking and poor diet), genetics, and underlying medical conditions (such as high blood pressure and diabetes). Cardiovascular disease is a leading cause of death worldwide, but can often be prevented or managed through lifestyle changes, medications, and medical procedures such as bypass surgery and angioplasty.” data-gt-translate-attributes=”[{“attribute”:”data-cmtooltip”, “format”:”html”}]” tabindex=”0″ role=”link”>cardiovascular disease. When evaluated at Lahey Hospital and Medical Center six weeks after his cardiac arrest, he was asymptomatic and neurologically intact, without residual medical problems, and had begun to resume normal daily activities without difficulty.
The commotio cordis event reported here is notable for expanding the clinical spectrum of commotio cordis, given that competitive basketball previously had not been associated with this cause of cardiac arrest. Contact sports such as baseball/softball and hockey have dominated commotio cordis, owing to the greater possibility of physical contact and chest blows from hard-core projectiles (e.g., balls and pucks).
Dr. Maron concludes, “In this report, we have underscored once again that commotio cordis can occur under virtually any circumstance where there is the possibility of physical bodily contact of any magnitude, or projectile-induced chest blows, but always when least expected. This may be the best-documented case we have of commotio cordis, which should go a long way to dispel skepticism.”
Reference: “Commotio cordis…once again: Unusual occurrence in a noncontact sport” by Barry J. Maron, Ethan J. Rowin and Martin S. Maron, 13 November 2023, HeartRhythm Case Reports.
DOI: 10.1016/j.hrcr.2023.10.013
Source: SciTechDaily
