Commotio Cordis

What causes commotio cordis?

Commotio cordis occurs due to a sudden blow to the left side of the chest during a small window in the heart rhythm. This can trigger ventricular fibrillation, a life-threatening arrhythmia that causes the heart to stop pumping effectively and can result in sudden cardiac arrest.

Baseball has caused the most reported cases. Other harder, round objects such as softballs, lacrosse balls and hockey pucks carry higher risk. In some cases, commotio cordis can result from other types of strong impact, such as car accidents or assault.

What are the risk factors for commotio cordis?

There are no specific risk factors for commotio cordis. Many reported cases have been in young male athletes between the ages of 11 and 20. Very few have been reported for people over age 20. Experts believe it is more common in younger people due to their thinner, less developed chest wall. Cases may also be higher in younger people because fewer adults play sports such as baseball, lacrosse and hockey.

While rare, it is one of the most frequent causes of death in young athletes. Researchers believe it may be an underreported medical condition.

What are the symptoms of commotio cordis?

The symptoms may include:

• Sudden collapse, though a person may be able to remain active for several seconds before falling down
• Lack of responsiveness
• No breath, pulse or heartbeat

How should you respond to commotio cordis?

If you think someone could be suffering from a cardiac arrest caused by commotio cordis, start an emergency medical response right away. These three critical steps in the chain of survival could save a life:

• Call 911.
• Start CPR. If the person isn’t breathing or is only gasping, start CPR with compressions by pressing hard and fast on the center of the chest. Continue CPR until the person starts to breathe or move, or until someone with more advanced training takes over.
• Use an AED. Use an AED as soon as one is available to shock the heart into normal rhythm.

How do you treat commotio cordis?

The most important way to treat commotio cordis is to recognize it right away and start an emergency medical response:

• Call 911.
• Start CPR.
• Use an AED to get the heart beating normally again.

The current survival rate for commotio cordis is above 50%. Starting CPR right away and using an AED is the best way to save someone’s life after commotio cordis. An AED must be used within 3-5 minutes for the best chance of survival.

How can you prevent commotio cordis?

It is hard to remove all risk of commotio cordis, especially for athletes or people who engage in recreational activities with a chance of physical contact. You can do a few important things to prevent commotio cordis and improve the outlook for anyone who experiences it.

• Create and implement a Cardiac Emergency Response Plan, or CERP.
• Learn the signs of commotio cordis so you can start the chain of survival that could save someone’s life. Call 911, administer CPR and use an AED.
• Keep an AED at athletic and recreational facilities. An AED could increase the odds of survival in the event of commotio cordis.
• Train coaches and other athletic personnel, teachers, parents and students in CPR.
• Adapt your athletic activities and learn safe playing techniques to avoid hard blows to the chest. For example:
  • If you’re playing baseball and up at bat, turn your body away from any pitches that could hit your chest.
  • If you’re playing defense in lacrosse or hockey, avoid using your chest to block the ball or puck.
• Use safety baseballs or T-balls, especially for younger children. They are softer and more flexible than standard baseballs.

What is the difference between commotio cordis and sudden cardiac arrest?

Commotio cordis and sudden cardiac arrest both involve a cardiac arrest. A big difference is what causes the cardiac arrest. Commotio cordis is caused by a blunt impact to the chest during a small window of the heartbeat, when the heart is preparing to contract. This triggers cardiac arrest.

Sudden cardiac arrest happens when the heart unexpectedly stops beating.  It may be linked to heart disease or other factors that cause the heart’s electrical system to malfunction.

How do you stay healthy after commotio cordis?

There is no evidence that survivors of commotio cordis are at a higher risk for other heart events. It’s very unlikely that someone would have two cases of commotio cordis. If you’ve had commotio cordis, talk with your health care professional about a safe return to physical activity. Survivors should have a full cardiac evaluation to rule out heart disease. This may include one or more of the following tests:

• Electrocardiogram or EKG
• Echocardiogram
• Cardiac imaging
• Stress testing