Commotio Cordis
Background
Sudden death during sports are caused by
Structural lesion
- Anomalous origin coronary artery
- HOCM
Congenital long QTc interval
- Projectile strikes precordium (Commotio Cordis)
Electrolyte abnormality
Commotio cordis
- Concussion of the heart
- Young athletes (Male 4 - 16 yo)
- Low energy impact to chest - usually with ball - directly over ventricle - not precordium
- Timing of impact must be precise (30 - m15 msec before peak T wave)
- Presumed selective K+ channel activation
- Immediate VF or occasional transient heart block (occasional LBBB)
- Survivors all have - impressive transient ST segment elevation (V1- V3) and normal investigations including QTc
- Only treatment is Early Defibrillation (and early CPR)
Links
- Commotio Cordis. NEJM 2002;147(16);1248
- An Experimental Model of Sudden Death Due to Low-Energy Chest-Wall Impact (Commotio Cordis). NEJM 1998;338(25);1805-11
Content by Dr Íomhar O' Sullivan 16/08/2004. Reviewed by dr ÍOS 16/01/2007, 10/06//2008. Last review Dr ÍOS 21/06/21.