Commotio Cordis


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

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.