What is Commotio Cordis?

In January, NFL’s Damar Hamlin shocked the entire world when he suddenly collapsed in the middle of the game when the football hit his chest. The Buffalo Bills’ safety lay on the field for about 10 minutes as the emergency medical staff gave him CPR to resuscitate him. Fortunately, the football player received crucial medical help at the right time and is now back on his feet.

Although the sudden collapse of the player befuddled fans, Hamlin’s doctor said that he suffered from a rare phenomenon: commotio cordis.

What is Commotio Cordis?

Commotio Cordis is a rare phenomenon that occurs when a person is struck with a blunt force on the left side of the chest where the heart resides. The condition occurs during a critical period in the cardiac cycle that does not last for more than 30 milliseconds. This is when the lower chambers of the heart, known as the ventricles, are relaxing after a contraction. The force of the blow makes the ventricles contract when they are supposed to be expanding, resulting in arrhythmia and, consequently, sudden cardiac arrest.

Commotio cordis should not be confused with contusio cordis or cardiac contusion, which is a condition caused by blunt force trauma to the chest, resulting in lesions, tera, or damage to the heart. This condition is most often seen in motor vehicle accidents.

Cause of Commotio Cordis

The cause of commotio cordis is usually associated with sports, though not always. The blunt force to the heart often comes from a blunt and a hard object hitting the chest, such as a baseball, football, softball, or hockey puck. However, a fist or another blunt object can also result in this phenomenon.

These projectiles strike the chest wall with a high enough impact that causes the heart to enter arrhythmia. In martial arts, a strike of a hand to the chest can cause a person’s heart to go out of rhythm.

More than half (61%) of commotio cordis incidents have been associated with baseball and have been caused by the baseball striking the player on the chest wall about the heart. Batters, pitchers, and catchers have the highest incidence of chest wall strikes, but other players can also be affected by commotio cordis.

Some other common sports that can result in commotio cordis are lacrosse, hockey, softball, and other contact sports. In sports that do not involve a ball, commotio cordis can be caused by impacts with helmets, fists, knees, and elbows. Commotio cordis can also happen when doing routine activities at home, which results in an impact to the chest wall.

Fortunately, the phenomenon is rare, with only about 20 to 30 cases in a year.

Symptoms of Commotio Cordis

A person experiencing commotio cordis will exhibit the following symptoms:

• Sudden collapse after the strike to the chest, sometimes with a few seconds of stumbling
• Ventricular fibrillation
• Lack of pulse or heartbeat
• Cardiac arrest
• Gasping breaths
• May not be breathing
• Jerking movements in the arms and leg
• Bluish skin due to lack of oxygen
• Bruising to the chest
• Seizures

Without emergency CPR and defibrillation, the rate of survival of people with commotio cordis is very, very low.

Risk Factors of Commotio Cordis

Most of the people who experience commotio cordis are athletes participating in organized sports, since this is the most high-risk setting for such an incident. Commotio cordis primarily affects people between the ages of 10 and 18. In fact, 95 percent of reported victims in the US are male and 78 percent of them are white.

Commotio cordis victims over the age of 20 are very rare. Some experts believe that this is because age stiffens the chest wall and hence results in decreased incidents in older people. However, it may also be due to the fact that older individuals have decreased participation in ball-related sports.

A partial explanation of why the overwhelming majority of victims are male is that men participate in the majority of the games and sports where commotio cordis can occur. However, some also believe that higher incidents of commotio cordis in male is due to gender-related reasons.

Treatment of Commotio Cordis

A person with commotio cordis will become unconscious, and their heart must be assumed to have stopped beating. In this case, immediate medical attention is needed for cardiac arrest. It is important that 911 be called immediately as CPR is provided with chest compressions. The use of an AED (automated external defibrillator) is also crucial, and a life-saving electric shock needs to be delivered to the victim as soon as possible. The medical team or any individual who is giving treatment should continue emergency support until the ambulance arrives.

After getting emergency treatment, the victim will be sent to an emergency room, where they will be given appropriate treatment until they have stabilized. The medical team will continue to monitor them and find out if their heart is functioning after the incident. They will also assess the patient for any undiagnosed heart issues.

How Can You Prevent Commotio Cordis?

Although it may not be possible to completely eliminate incidents of commotio cordis, organized sports can play a major role in reducing these events or at least preventing the death of the players.

Some research has looked into the benefits of using protective equipment like padded chest vests when participating in contact sports.

It is important that an athletic trainer be present during game practices and matches to ensure all the players are following the proper technique and rules of the game to reduce incidents of injuries. This includes discouraging players from blocking balls or a swing force with their chest. In games like baseball, coaches can teach players to avoid errant balls by turning away their bodies.

Improvements in the design of sports equipment, like the use of rubber safety baseballs, can also help to decrease these incidents.

It is also important for trainers, coaches, players, and spectators to remain proactive and alert if they see an athlete injured on the field. Everyone should learn CPR to initiate timely resuscitation while the ambulance arrives.

Another very important factor is the availability and use of AEDs, which deliver electric shocks to help the victim regain their heartbeat.

These measures are more likely to result in saving the lives of athletes suffering from commotio cordis on the field.

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Getting hit in the chest can result in serious injuries and can be potentially fatal; fortunately, the odds of surviving commotio cordis is now higher than ever. With quick and proactive medical attention, people can survive and make a full recovery. CPR training and accessibility to AEDs may also reduce the risk of fatalities from this phenomenon.

If you or anyone you love is exhibiting symptoms of a cardiovascular issue, it is important to get yourself checked. Visit Keystone Cardiovascular Center and call Dr. Demetrios Panagiotou. Call us at 201-447-3690 to schedule an appointment.