Skip to main content
Top
Published in: Sports Medicine 4/2000

01-10-2000 | Injury Clinic

Commotio Cordis

An Underappreciated Cause of Sudden Death in Athletes

Author: Dr Fatimah Lateef

Published in: Sports Medicine | Issue 4/2000

Login to get access

Abstract

Over the last few years, the recognised cardiovascular risks of sporting activities have been extended to include cardiac arrest resulting from low-energy precordial chest impact produced by projectiles (e.g. baseball) or bodily contact, in the young, healthy and active athlete [also known as commotio cordis (CC)]. However, case reports of CC in European medical literature can be traced back for at least 130 years.
CC accounts for a small, but important, subset of sudden death during sporting activities. It is a devastating electrophysiological event in the young athlete, and one which has generated considerable concern, both in the medical profession as well as in the public.
The mechanism of sudden death appears to be caused by ventricular fibrillation, which occurs when the chest impact is delivered within a narrow, electrically vulnerable portion of the cardiac cycle, that is, during repolarisation, just before the peak of the T wave. Resuscitation of these victims is possible with prompt cardiopulmonary resuscitation and defibrillation. Preventive measures, such as the use of age-appropriate safety baseballs and suitably designed chest wall protection, may reduce the risk of sudden death and, thus, make the athletic field a safer place for young athletes.
Literature
1.
go back to reference Rasdorff EJ, Prodinger RJ. Sudden cardiac death in the athlete. Emerg Med Clin of North Am 1998 May; 16 (2): 281–93CrossRef Rasdorff EJ, Prodinger RJ. Sudden cardiac death in the athlete. Emerg Med Clin of North Am 1998 May; 16 (2): 281–93CrossRef
2.
go back to reference Maron BJ. Sudden death in young athletes: lessons from the Hank Gathers affair. N Engl J Med 1993; 329 (1): 55–7PubMedCrossRef Maron BJ. Sudden death in young athletes: lessons from the Hank Gathers affair. N Engl J Med 1993; 329 (1): 55–7PubMedCrossRef
3.
go back to reference Maron BJ, Epstein SE, Roberts WC. Causes of sudden death in competitive athletes. J Am Coll Cardiol 1986 Jan; 7 (1): 204–14CrossRef Maron BJ, Epstein SE, Roberts WC. Causes of sudden death in competitive athletes. J Am Coll Cardiol 1986 Jan; 7 (1): 204–14CrossRef
4.
go back to reference Basso C, Corrado D, Thiene G. Cardiovascular causes of sudden death in young individuals including athletes. Cardiol Rev 1999 May–Jun; 7 (3): 127–35PubMedCrossRef Basso C, Corrado D, Thiene G. Cardiovascular causes of sudden death in young individuals including athletes. Cardiol Rev 1999 May–Jun; 7 (3): 127–35PubMedCrossRef
5.
go back to reference van Camp SP, Bloor CM, Mueller PO, et al. Non-traumatic sports death in high school and college athletes. Med Sci Sports Exerc 1995; 27: 641–7PubMed van Camp SP, Bloor CM, Mueller PO, et al. Non-traumatic sports death in high school and college athletes. Med Sci Sports Exerc 1995; 27: 641–7PubMed
6.
go back to reference Maron BJ. Cardiovascular risks to young people on the athletic field. Ann Intern Med 1998 Sep; 129 (5): 379–86PubMed Maron BJ. Cardiovascular risks to young people on the athletic field. Ann Intern Med 1998 Sep; 129 (5): 379–86PubMed
7.
go back to reference Virmani R, Burke AP, Farb A, et al. Causes of sudden death in young and middle-aged competitive athletes. Cardiol Clin 1997 Aug; 15 (3): 439–66PubMedCrossRef Virmani R, Burke AP, Farb A, et al. Causes of sudden death in young and middle-aged competitive athletes. Cardiol Clin 1997 Aug; 15 (3): 439–66PubMedCrossRef
8.
go back to reference Maron BJ, Link MS, Wang PJ, et al. Clinical profile of commotio cordis: an under-appreciated cause of sudden death in the young during sports and other activities. J Cardiovasc Electrophys 1999 Jan; 10: 114–20CrossRef Maron BJ, Link MS, Wang PJ, et al. Clinical profile of commotio cordis: an under-appreciated cause of sudden death in the young during sports and other activities. J Cardiovasc Electrophys 1999 Jan; 10: 114–20CrossRef
9.
go back to reference Maron BJ, Poliac LC, Kaplan JA, et al. Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. N Engl J Med 1995 Aug 10; 333 (6): 337–42PubMedCrossRef Maron BJ, Poliac LC, Kaplan JA, et al. Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. N Engl J Med 1995 Aug 10; 333 (6): 337–42PubMedCrossRef
10.
go back to reference Nelaton A. Element de pathologie chirurgicale. Paris: Librairie Germer Bateliere et Co, 1876 Nelaton A. Element de pathologie chirurgicale. Paris: Librairie Germer Bateliere et Co, 1876
11.
go back to reference Meola F. La commonzione thoracica. G Int Sci Med 1879; 1: 923–37 Meola F. La commonzione thoracica. G Int Sci Med 1879; 1: 923–37
12.
go back to reference Riedinger J. Ueber herzaffectionen nach unfallen. Monatsschr Unfallheilkunde 1894; 1: 351–6 Riedinger J. Ueber herzaffectionen nach unfallen. Monatsschr Unfallheilkunde 1894; 1: 351–6
13.
go back to reference Riedinger J, Kummel H. Die verletzengen und erkrankungen des thorax und seines inhaltes. In: Bergman EV, Bruns PV, editors. Handbuch der praktishen chirurgie. Stuggart: Enke 1903; 1: 373–456 Riedinger J, Kummel H. Die verletzengen und erkrankungen des thorax und seines inhaltes. In: Bergman EV, Bruns PV, editors. Handbuch der praktishen chirurgie. Stuggart: Enke 1903; 1: 373–456
14.
go back to reference Reinebroth F. Der Einflussder der erschutterungdes brustkorbes auf die gefasse der pleura and lunge und ein entstehungsmodusder traumatischen haemoptoe. Munch Med Wochenschr 1898; 37: 1170–72 Reinebroth F. Der Einflussder der erschutterungdes brustkorbes auf die gefasse der pleura and lunge und ein entstehungsmodusder traumatischen haemoptoe. Munch Med Wochenschr 1898; 37: 1170–72
15.
go back to reference Schlomka G, Hinrichs A. Experimentelle untersuchungen uber den einflu stumpfer brustkorbverletzungen auf das elektrokardiogramm. Z Gesamte Exp Med 1932; 81: 43–61CrossRef Schlomka G, Hinrichs A. Experimentelle untersuchungen uber den einflu stumpfer brustkorbverletzungen auf das elektrokardiogramm. Z Gesamte Exp Med 1932; 81: 43–61CrossRef
16.
go back to reference Schlomka G, Schmitz M. Experimentelle untersuchungen uber den einflu stumpfer brustkorbverletzungen auf das elektrokardiogramm (II Mitteilung). Z Gesamte Exp Med 1932; 83: 779–91CrossRef Schlomka G, Schmitz M. Experimentelle untersuchungen uber den einflu stumpfer brustkorbverletzungen auf das elektrokardiogramm (II Mitteilung). Z Gesamte Exp Med 1932; 83: 779–91CrossRef
17.
go back to reference Lab MJ. Mechanoelectric feedback in heart: concepts and implications. Cardiovasc Res 1996 Jul; 32 (1): 3–14PubMed Lab MJ. Mechanoelectric feedback in heart: concepts and implications. Cardiovasc Res 1996 Jul; 32 (1): 3–14PubMed
18.
go back to reference Hediger C. Beitrage zur pathologischen anatomie der contusio end commotio cordis. Cardiologia 1944; 8: 1–48CrossRef Hediger C. Beitrage zur pathologischen anatomie der contusio end commotio cordis. Cardiologia 1944; 8: 1–48CrossRef
19.
go back to reference Parmley L, Manion N, Mattingly T. Non-penetrating traumatic injury to the heart. Circulation 1958; 18: 371–93PubMedCrossRef Parmley L, Manion N, Mattingly T. Non-penetrating traumatic injury to the heart. Circulation 1958; 18: 371–93PubMedCrossRef
20.
go back to reference Golikov AP, Borisenkko AP. Manifestation and pathogenesis of cardiac trauma. Ter Arkh 1976; 48: 88–94PubMed Golikov AP, Borisenkko AP. Manifestation and pathogenesis of cardiac trauma. Ter Arkh 1976; 48: 88–94PubMed
21.
go back to reference Lindsey D, Froede RC, Steinbronn K. Sudden unexpected death from cardiac concussion (commotio cordis) with unusual legal complications. J Forensic Sci 1979; 24: 752–6PubMed Lindsey D, Froede RC, Steinbronn K. Sudden unexpected death from cardiac concussion (commotio cordis) with unusual legal complications. J Forensic Sci 1979; 24: 752–6PubMed
22.
go back to reference Liedtke AJ, Gault JH, Demuth WE. Electrocardiographic and hemodynamic changes following non-penetrating chest trauma in the experimental animal. Am J Physiol 1974; 226: 377–82PubMed Liedtke AJ, Gault JH, Demuth WE. Electrocardiographic and hemodynamic changes following non-penetrating chest trauma in the experimental animal. Am J Physiol 1974; 226: 377–82PubMed
23.
go back to reference Liedtke AJ, Allen RP, Nellis SH. Effects of blunt cardiac trauma on coronary vasomotion, perfusion, myocardial mechanics and metabolism. J Trauma 1980; 20: 777–85PubMedCrossRef Liedtke AJ, Allen RP, Nellis SH. Effects of blunt cardiac trauma on coronary vasomotion, perfusion, myocardial mechanics and metabolism. J Trauma 1980; 20: 777–85PubMedCrossRef
24.
go back to reference Morikawa M, Hirose K, Mori T, et al. Myocardial contusion caused by baseball. Clin Cardiol 1996 Oct; 19 (10): 831–3PubMedCrossRef Morikawa M, Hirose K, Mori T, et al. Myocardial contusion caused by baseball. Clin Cardiol 1996 Oct; 19 (10): 831–3PubMedCrossRef
25.
go back to reference Abrunzo TJ. Commotio cordis: the single most common cause of traumatic death in youth baseball. Am J Dis Child 1991 Nov; 145 (11): 1 279–82 Abrunzo TJ. Commotio cordis: the single most common cause of traumatic death in youth baseball. Am J Dis Child 1991 Nov; 145 (11): 1 279–82
26.
go back to reference Futterman LG, Lemberg L. Commotio cordis: sudden cardiac death in athletes. Am J Crit Care 1999 Jul; 8 (40); 270–2PubMed Futterman LG, Lemberg L. Commotio cordis: sudden cardiac death in athletes. Am J Crit Care 1999 Jul; 8 (40); 270–2PubMed
27.
go back to reference Deady B, Innes G. Sudden death of a hockey player: case report of commotio cordis. J Emerg Med 1999 May–Jun; 17 (30): 459–62PubMedCrossRef Deady B, Innes G. Sudden death of a hockey player: case report of commotio cordis. J Emerg Med 1999 May–Jun; 17 (30): 459–62PubMedCrossRef
28.
go back to reference Kaplan JA, Karofsky PS, Volturo GA. Commotio cordis in 2 amateur ice-hockey players despite the use of commercial chest protectors: case reports. J Trauma 1993 Jan; 34 (1); 151–3PubMedCrossRef Kaplan JA, Karofsky PS, Volturo GA. Commotio cordis in 2 amateur ice-hockey players despite the use of commercial chest protectors: case reports. J Trauma 1993 Jan; 34 (1); 151–3PubMedCrossRef
29.
go back to reference Sadler DW. Commotio cordis: sudden death due to chest wall impact in sports [letter]. Heart 1999 Oct; 82: 534PubMed Sadler DW. Commotio cordis: sudden death due to chest wall impact in sports [letter]. Heart 1999 Oct; 82: 534PubMed
30.
go back to reference Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes: clinical, demographic and pathological profiles. JAMA 1996; 276: 199–204PubMedCrossRef Maron BJ, Shirani J, Poliac LC, et al. Sudden death in young competitive athletes: clinical, demographic and pathological profiles. JAMA 1996; 276: 199–204PubMedCrossRef
31.
go back to reference Link MS, Wang PJ, Pandian NG, et al. An experimental model of sudden death due to low-energy chest wall impact (commotio cordis). N Engl J Med 1998 Jun 18; 338 (25): 1805–11PubMedCrossRef Link MS, Wang PJ, Pandian NG, et al. An experimental model of sudden death due to low-energy chest wall impact (commotio cordis). N Engl J Med 1998 Jun 18; 338 (25): 1805–11PubMedCrossRef
32.
go back to reference Kroell CK, Allen S, Warner CY, et al. Inter-relationship of velocity and chest compression in blunt thoracic impact to swines [Society of Automotive Engineers (SAE) technical paper 861881]. Proceedings of the 30th Stapp Car Crash Conference. Warrendale (PA): Society of Automotive Engineers, 1986: 99 Kroell CK, Allen S, Warner CY, et al. Inter-relationship of velocity and chest compression in blunt thoracic impact to swines [Society of Automotive Engineers (SAE) technical paper 861881]. Proceedings of the 30th Stapp Car Crash Conference. Warrendale (PA): Society of Automotive Engineers, 1986: 99
33.
go back to reference Viano DC, Lau IV. Role of impact velocity and chest compression in thoracic injury. Aviat Space Environ Med 1983; 54: 16–21PubMed Viano DC, Lau IV. Role of impact velocity and chest compression in thoracic injury. Aviat Space Environ Med 1983; 54: 16–21PubMed
34.
go back to reference Viano DC, Lau IV. A viscous tolerance criterion for soft tissue injury assessment. J Biomech 1988; 21: 387–99PubMedCrossRef Viano DC, Lau IV. A viscous tolerance criterion for soft tissue injury assessment. J Biomech 1988; 21: 387–99PubMedCrossRef
35.
go back to reference Balser JR. Sodium ‘channelopathies’ and sudden death: must you be so sensitive? Circ Res 1999; 85: 872–4PubMedCrossRef Balser JR. Sodium ‘channelopathies’ and sudden death: must you be so sensitive? Circ Res 1999; 85: 872–4PubMedCrossRef
37.
go back to reference Isomoto S, Kurachi Y. Function, regulation, pharmacology and molecular structure of ATP-sensitive K+ channels in the cardiovascular system. J Cardiovasc Electrophys 1997; 8: (1) 431–46CrossRef Isomoto S, Kurachi Y. Function, regulation, pharmacology and molecular structure of ATP-sensitive K+ channels in the cardiovascular system. J Cardiovasc Electrophys 1997; 8: (1) 431–46CrossRef
38.
go back to reference Billman GE. Role of ATP-sensitive K+ channels in extracellular K+ accumulation and cardiac arrhythmia during myocardial ischemia. Cardiovasc Res 1994; 28: 762–9PubMedCrossRef Billman GE. Role of ATP-sensitive K+ channels in extracellular K+ accumulation and cardiac arrhythmia during myocardial ischemia. Cardiovasc Res 1994; 28: 762–9PubMedCrossRef
39.
go back to reference Findlay I. Inhibition of ATP-sensitive K+ channels in cardiac muscle by the sulphonylurea drug, glibenclamide. J Pharmacol Exp Ther 1992; 261: 540–5PubMed Findlay I. Inhibition of ATP-sensitive K+ channels in cardiac muscle by the sulphonylurea drug, glibenclamide. J Pharmacol Exp Ther 1992; 261: 540–5PubMed
40.
go back to reference Link MS, Wang PJ, Vanderbrink BA, et al. Selective activation of the K+-ATP channel is a mechanism by which sudden death is produced by low-energy chest wall impact (commotio cordis). Circulation 1999; 100: 413–8PubMedCrossRef Link MS, Wang PJ, Vanderbrink BA, et al. Selective activation of the K+-ATP channel is a mechanism by which sudden death is produced by low-energy chest wall impact (commotio cordis). Circulation 1999; 100: 413–8PubMedCrossRef
41.
go back to reference Hamlin RL, Burton RR, Leverett SD, et al. The ECG from miniature swines recorded with the Mc Fee-axial Reference Program. J Electrocardiol 1974; 7: 155–62PubMedCrossRef Hamlin RL, Burton RR, Leverett SD, et al. The ECG from miniature swines recorded with the Mc Fee-axial Reference Program. J Electrocardiol 1974; 7: 155–62PubMedCrossRef
42.
go back to reference Kyle SB. Youth Baseball protective equipment project: final report. Washington, DC: Consumer Product Safety Commission, 1996 Kyle SB. Youth Baseball protective equipment project: final report. Washington, DC: Consumer Product Safety Commission, 1996
43.
go back to reference Janda DH, Viano DC, Andrzejak DV, et al. An analysis of preventive methods for baseball-induced chest impact injuries. Clin J Sports Med 1992; 2: 172–9CrossRef Janda DH, Viano DC, Andrzejak DV, et al. An analysis of preventive methods for baseball-induced chest impact injuries. Clin J Sports Med 1992; 2: 172–9CrossRef
44.
45.
go back to reference Crown LA, Hawkins W. Commotio cordis: clinical implications of blunt cardiac trauma. AmFam Physician 1997 May; 55 (7): 2467–70PubMed Crown LA, Hawkins W. Commotio cordis: clinical implications of blunt cardiac trauma. AmFam Physician 1997 May; 55 (7): 2467–70PubMed
46.
go back to reference Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular preparticipation screening of competitive athletes. Circulation 1996; 94: 850–6PubMedCrossRef Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular preparticipation screening of competitive athletes. Circulation 1996; 94: 850–6PubMedCrossRef
47.
go back to reference Maron BJ, Mitchell JH. 26th Bethesda conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. Med Sci Sports Exerc 1994; 26 Suppl.: S223–83PubMed Maron BJ, Mitchell JH. 26th Bethesda conference: recommendations for determining eligibility for competition in athletes with cardiovascular abnormalities. Med Sci Sports Exerc 1994; 26 Suppl.: S223–83PubMed
48.
go back to reference Ewy GA, Ornato JP. 31st Bethesda conference: emergency cardiac care. Task Force 1: Cardiac Arrest. J Am Coll Cardiol 2000 Mar; 35 (4): 832–46PubMedCrossRef Ewy GA, Ornato JP. 31st Bethesda conference: emergency cardiac care. Task Force 1: Cardiac Arrest. J Am Coll Cardiol 2000 Mar; 35 (4): 832–46PubMedCrossRef
49.
go back to reference McGrew CA. Insights into the AHA Scientific Statement concerning cardiovascular pre-participation screening of competitive athletes. Med Sci Sports Exerc 1998 Oct; 30 (10 Suppl.): S351–3PubMed McGrew CA. Insights into the AHA Scientific Statement concerning cardiovascular pre-participation screening of competitive athletes. Med Sci Sports Exerc 1998 Oct; 30 (10 Suppl.): S351–3PubMed
50.
go back to reference Maron BJ, Strasburger JF, Kugler JD, et al. Survival following blunt chest impact-induced cardiac arrest during sports activities in young athletes. Am J Cardiol 1997 Mar; 79 (6): 840–1PubMedCrossRef Maron BJ, Strasburger JF, Kugler JD, et al. Survival following blunt chest impact-induced cardiac arrest during sports activities in young athletes. Am J Cardiol 1997 Mar; 79 (6): 840–1PubMedCrossRef
51.
go back to reference Link MS, Ginsburg SH, Wang PJ, et al. Commotio cordis: cardiovascular manifestations of a rare survivor. Chest 1998 Jul; 114 (1): 326–8PubMedCrossRef Link MS, Ginsburg SH, Wang PJ, et al. Commotio cordis: cardiovascular manifestations of a rare survivor. Chest 1998 Jul; 114 (1): 326–8PubMedCrossRef
Metadata
Title
Commotio Cordis
An Underappreciated Cause of Sudden Death in Athletes
Author
Dr Fatimah Lateef
Publication date
01-10-2000
Publisher
Springer International Publishing
Published in
Sports Medicine / Issue 4/2000
Print ISSN: 0112-1642
Electronic ISSN: 1179-2035
DOI
https://doi.org/10.2165/00007256-200030040-00005

Other articles of this Issue 4/2000

Sports Medicine 4/2000 Go to the issue