Background
Sudden death during sports are caused by:
Structural lesion
- HOCM
- Anomalous origin coronary art
Congenital long QTc interval
Commotio Cordis
- Projectile strikes precordium
Electrolyte abnormality
Commotio cordis
- Concussion of the heart
- Dx of exclusion (see DDx)
- Young athletes (Male, 4 - 16 yo)
- Low energy (ball) impact to chest - directly over ventricle - not precordium
- ± transient delay to collapse
- Timing of impact must be precise (30 - 15 msec before peak T wave)
- Presumed selective K+ channel activation (K+ influx → R on T)
- Immediate VF or occasional transient heart block (occasional LBBB)
- Survivors have - transient ST segment elevation (V1- V3) & normal Ix., incl. QTc
- Only treatment = early CPR & defibrillation
Differential Dx
- HOCM
- Long QT syndrome
- Brugada syndrome
- Arrhythmogenic right ventricular dysplasia (ARVD)
- Myocarditis
- Electrolyte abnormalities
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