Hostname: page-component-54dcc4c588-rz4zl Total loading time: 0 Render date: 2025-10-08T00:46:01.621Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiac concussion (commotio cordis)

Published online by Cambridge University Press:  21 May 2015

Rahim Valani ,
Angelo Mikrogianakis  and
Ran D. Goldman
Rahim Valani
Affiliation:
Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ont.
Angelo Mikrogianakis
Affiliation:
Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ont.
Ran D. Goldman*
Affiliation:
Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ont.
*
Division of Emergency Services, Hospital for Sick Children, 555 University Ave., Toronto ON M5G 1X8; 416 813-4915, fax 416 813-5043, ran.goldman@sickkids.ca

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Blunt chest trauma in pediatric patients can result in various injuries to the myocardium. Cardiac concussion (commotio cordis) is seen in patients in whom the precordium has been struck with relatively little force at a vulnerable period of the cardiac cycle. These patients have no predisposing cardiac problems, and autopsy reveals no evidence of heart damage. The usual clinical presentation is that of immediate collapse secondary to a lethal arrhythmia. Prevention is the cornerstone of potentially decreasing the incidence with the aid of safety equipment and, possibly, immediate defibrillation.

Keywords

commotio cordischest traumapediatricdefibrillationresuscitation

Information

Type
Pediatric Em • Pédiatrie D’urgence
Information
Canadian Journal of Emergency Medicine , Volume 6 , Issue 6 , November 2004 , pp. 428 - 430
Copyright
Copyright © Canadian Association of Emergency Physicians 2004

References

1.Committee on Trauma Research (US). Injury in America: a continuing public health problem. Committee on Trauma Research, Commission on Life Sciences, National Research Council and the Institute of Medicine, Washington, DC: National Academy Press; 1985.Google Scholar
2.World Health Statistical Annual, 1994. Geneva, Switzerland: WHO; 1994.Google Scholar
3.McCrory, P.Commotio cordis. Br J Sports Med 2002;36:236–7.CrossRefGoogle ScholarPubMed
4.Maron, BJ, Link, MS, Wang, PJ, Estes, NA 3rd. Clinical profile of commotio cordis: an under appreciated cause of sudden death in the young during sports and other activities. J Cardiovasc Electrophysiol 1999;10(1):114–20.CrossRefGoogle Scholar
5.Maron, BJ, Gohman, TE, Kyle, SB, Estes, NA 3rd, Link, MS.Clinical profile and spectrum of commotio cordis. JAMA 2002;287(9):1142–6.Google Scholar
6.Link, MS, Wang, PJ, Estes, NA 3rd. Ventricular arrhythmias in the athlete. Curr Opin Cardiol 2001;16(1):30–9.CrossRefGoogle ScholarPubMed
7.Vincent, GM, McPeak, H.Commotio cordis: a deadly consequence of chest trauma. Physician Sportsmed 2000;28(11). Available: http://www.physsportsmed.com/issues/2000/11_00/vincent.htm (accessed 2004 Oct 25).CrossRefGoogle Scholar
8.Link, MS, Maron, BJ, Wang, PJ, Pandian, NG, VanderBrink, BA, Estes, NA 3rd. Reduced risk of sudden death from chest wall blows (commotio cordis) with safety baseballs. Pediatrics 2002;109(5):873–7.CrossRefGoogle ScholarPubMed
9.Perron, AD, Brady, WJ, Erling, BF.Commotio cordis: an underappreciated cause of sudden cardiac death in young patients: assessment and management in the ED. Am J Emerg Med 2001;19(5):406–9.Google Scholar
10.Abrunzo, TJ.Commotio cordis: the single, most common cause of traumatic death in youth baseball. Am J Dis Child 1991;145(11):1279–82.CrossRefGoogle ScholarPubMed
11.Kaplan, JA, Karofsky, PS, Volturo, GA.Commotio cordis in two amateur ice hockey players despite the use of commercial chest protectors: case reports. J Trauma 1993;34(1):151–3.CrossRefGoogle ScholarPubMed
12.Maron, BJ, Poliac, LC, Kaplan, JA, Mueller, FO.Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. N Engl J Med 1995;333(6):337–42.CrossRefGoogle Scholar
13.Curfman, GD.Fatal impact — concussion of the heart. N Engl J Med 1998;338(25):1841–3.CrossRefGoogle ScholarPubMed
14.Luckstead, EF, Patel, DR.Catastrophic pediatric sports injuries. Pediatr Clin North Am 2002;49(3):581–91.Google Scholar
15.Baker, AM, Craig, BR, Lonergan, GJ.Homicidal commotio cordis: the final blow in a battered infant. Child Abuse Negl 2003;27(1):125–30.CrossRefGoogle Scholar
16.Denton, JS, Filkins, JA, Stephenson, D.Criminal consequences of commotio cordis. Am J Cardiol 2002;90(10):1181–2.CrossRefGoogle ScholarPubMed
17.Maron, BJ, Mitten, MJ, Greene Burnett, C.Criminal consequences of commotio cordis. Am J Cardiol 2002;89(2):210–3.Google Scholar
18.Denton, JS, Kalelkar, MB.Homicidal commotion cordis in two children. J Forensic Sci 2000;45(3):734–5.Google Scholar
19.Boglioli, LR, Taff, ML, Harleman, G.Child homicide caused by commotio cordis. Pediatr Cardiol 1998;19:436–8.Google Scholar
20.Link, MS, Wang, PJ, Pandian, NG, Bharati, S, Udelson, JE, Lee, MY, et al. An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis) N Engl J Med 1998;338(25):1805–11.Google Scholar
21.Link, MS, Maron, BJ, VanderBrink, BA, Takeuchi, M, Pandian, NG, Wang, PJ, et al. Impact directly over the cardiac silhouette is necessary to produce ventricular fibrillation in an experimental model of commotio cordis. J Am Coll Cardiol 2001; 37(2):649–54.CrossRefGoogle Scholar
22.Liedtke, AJ, Allen, RP, Ellis, SH.Effects of blunt cardiac trauma on coronary vasoconstriction, perfusion, myocardial mechanics, and metabolism. J Trauma 1980; 20:777–85.Google Scholar
23.Link, MS, Maron, BJ, Wang, PJ, VanderBrink, BA, Zhu, W, Estes, NA 3rd. Upper and lower limits of vulnerability to sudden arrhythmic death with chest-wall impact (commotio cordis). J Am Coll Cardiol 2003;41(1):99–104.CrossRefGoogle ScholarPubMed
24.Chen, RL, Penny, DJ, Greve, G, Lab, MJ.Stretch-induced regional mechanoelectric dispersion and arrhythmia in the right ventricle of anesthetized lambs. Am J Physiol Heart Circ Physiol 2004;286(3):H1008–14.Google Scholar
25.Link, MS.Commotio cordis: sudden death due to chest wall impact in sports. Heart 1999;81(2):109–10.CrossRefGoogle ScholarPubMed
26.Futterman, LG, Lemberg, L.Commotio cordis: sudden cardiac death in athletes. Am J Crit Care 1999;8(4):270–2.CrossRefGoogle ScholarPubMed
27.Kohl, P, Nesbitt, AD, Cooper, PJ, Lei, M.Sudden cardiac death by commotio cordis: role of mechano-electric feedback. Cardiovasc Res 2001;50(2):280–9.CrossRefGoogle ScholarPubMed
28.Bir, CA, Viano, DC.Biomechanical predictor of commotio cordis in high-speed chest impact. J Trauma 1999;47(3):468–73.Google Scholar
29.Kroell, CK, Allen, S, Warner, CY.Inter-relationship of velocity and chest compression in blunt thoracic impact to swines. Society of Automotive Engineers (SAE) tech paper no 861881. Proceedings of the 30th Stapp Car Crash Conference, Warrendale, Pa. SAE, 1986: 99.Google Scholar
30.Lateef, F.Commotio cordis: an underappreciated cause of sudden death in athletes. Sport Med 2000;30(4):301–8.Google Scholar
31.Viano, DC, Bir, CA, Cheney, AK, Janda, DH.Prevention of commotion cordis in baseball: an evaluation of chest protectors. J Trauma 2000;19(6):1023–8.CrossRefGoogle Scholar
32.Strasburger, JF, Maron, BJ.Images in clinical medicine. Commotio cordis. N Engl J Med 2002;347(16):1248.CrossRefGoogle ScholarPubMed
33.Link, MS, Maron, BJ, Stickney, RE, Vanderbrink, BA, Zhu, W, Pandian, NG, et al. Automated external defibrillator arrhythmia detection in a model of cardiac arrest due to commotio cordis. J Cardiovasc Electrophysiol 2003;14(1):83–7.CrossRefGoogle Scholar