Sudden cardiac death following blunt chest trauma: commotio cordis

doi:10.5847/wjem.j.1920-8642.2011.03.015

Abstract

Abstract:

BACKGROUND: There have been numerous reports of sudden cardiac death attributable to the condition of commotio cordis. Primarily, these are reports from the USA. Although three Australian cases have been mentioned in the published literature, the present case appears to be the first described Australian case.
METHODS: A man was brought to the Emergency Department after sudden collapse while playing cricket. His medical history was suggestive of hitting by a cricket ball while batting.
RESULTS: The epidemiology and mechanism of arrhythmia induction in commotio cordis are discussed. The emergency management of commotio cordis is outlined.
CONCLUSIONS: Commotio cordis is rare in sports (and Emergency Medicine). However it has a high mortality rate, and rapid recognition of the condition allows early defibrillation, generally with a good outcome. The improvement of participant care is recommended at community and other sport events.

Key words: Arrhythmia, Sudden cardiac death, Commotio cordis, Cricket

Robert J Douglas. Sudden cardiac death following blunt chest trauma: commotio cordis[J]. World Journal of Emergency Medicine, 2011, 2(3): 234-236.

References 17

1	Morwood James. The pocket oxford latin dictionary. Oxford University Press, 1994.
2	Nelaton A. Elements de pathologie chirurgicale. Librairie Germer Bateliere, Paris, 1876.(Cited from Kohl P(1999). Commotio cordis: early observations (Letter). Heart 82:397. pmid: 10515692
3	Maron BJ. Cardiovascular risks to young persons on the athletic field. Ann Intern Med 1998; 129:379-386. doi: 10.7326/0003-4819-129-5-199809010-00006 pmid: 9735066
4	Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009; 119:1085-1092. doi: 10.1161/CIRCULATIONAHA.108.804617 pmid: 19221222
5	Maron BJ, Gohman TE, Kyle SB, Estes NA 3rd, Link MS. Clinical profile and spectrum of commotio cordis. JAMA 2002; 287:1142-1146. doi: 10.1001/jama.287.9.1142 pmid: 11879111
6	Maron BJ, Estes NA 3rd, Link MS Task Force 11: Commotio cordis. J Am Coll Cardiol 2005; 45:1371-1373 doi: 10.1016/j.jacc.2005.02.018 pmid: 15837291
7	Maron BJ, Doerer JJ, Haas TS, Estes NA, Hodges JS, Link MS. Commotio cordis and the epidemiology of sudden death in competitive lacrosse. Pediatrics 2009; 124:966-971 doi: 10.1542/peds.2009-0167 pmid: 19706581
8	Fox D. Lethal Impact. New Scientist 2003; 2410:38-39.
9	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; 37:649-654. doi: 10.1016/s0735-1097(00)01142-6 pmid: 11216992
10	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. N Engl J Med 1998; 338:180-181. pmid: 9441223
11	Madias C, Maron BJ, Supron S, Estes NA 3rd, Link MS. Cell membrane stretch and chest blow-induced ventricular fibrillation: commotio cordis. J Cardiovasc Electrophysiol 2008; 19:1304-1309. doi: 10.1111/j.1540-8167.2008.01267.x pmid: 18691236
12	Link MS, Wang PJ, VanderBrink BA, Avelar E, Pandian NG, Maron BJ, 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; 100:413-418. doi: 10.1161/01.cir.100.4.413 pmid: 10421603
13	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; 41:99-104. pmid: 12570951
14	Ngai KY, Chan HY, Ng F. A patient with commotio cordis successfully resuscitated by bystander cardiopulmonary resuscitation and automated external defibrillation. Hong Kong Med J 2010; 16:403-405. pmid: 20890008
15	Salib EA, Cyran SE, Cilley RE, Maron BJ, Thomas NJ. Efficacy of bystander cardiopulmonary resuscitation and out-of-hospital automated external defibrillation as life-saving therapy in commotio cordis. J Pediatr 2005; 147:863-866. doi: 10.1016/j.jpeds.2005.07.041 pmid: 16356450
16	Maron BJ, Wentzel DC, Zenovich AG, Estes NA 3rd, Link MS. Death in a young athlete due to commotio cordis despite prompt external defibrillation. Heart Rhythm 2005; 2:991-993. doi: 10.1016/j.hrthm.2005.06.016 pmid: 16171756
17	McCrory PR, Berkovic SF, Cordner SM. Deaths due to brain injury among footballers in Victoria, 1968-1999. Med J Aust 2005; 172:217-219. pmid: 10776393

[1]	Ya Zhong, Ping Cao, Chuan-feng Tong, Xia Li. Effects of ramipril on ventricular arrhythmia after myocardial infarction in rabbits [J]. World Journal of Emergency Medicine, 2014, 5(2): 135-138.
[2]	Jun Ke, Xing Xiao, Feng Chen, Li He, Mu-sen Dai, Xiao-ping Wang, Bing Chen, Min Chen, Cun-tai Zhang. Function of the CaMKII-ryanodine receptor signaling pathway in rabbits with left ventricular hypertrophy and triggered ventricular arrhythmia [J]. World Journal of Emergency Medicine, 2012, 3(1): 65-70.
[3]	Liang Chen, Hao Tang, Yan-bing Liang, Zhi-bin Chen, Zhen-yu Li, Zi-tong Huang, Long-yuan Jiang, Zhong-fu Ma. Expressions of SOCS-1 and SOCS-3 in the myocardium of patients with sudden cardiac death [J]. World Journal of Emergency Medicine, 2010, 1(2): 99-103.
[4]	Yu Chen, Zhi-jian Chen, Yu-hua Liao, Zhe Cao, Jia-ding Xia, Hua Yang, Yi-mei Du. Effect of tumor necrosis factor-α on ventricular arrhythmias in rats with acute myocardial infarction in vivo [J]. World Journal of Emergency Medicine, 2010, 1(1): 53-58.