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)

Differential Dx

• HOCM
• Long QT syndrome
• Brugada syndrome
• Arrhythmogenic right ventricular dysplasia (ARVD)
• Myocarditis
• Electrolyte abnormalities