Commotio cordis is a rare cause of sudden death that can occur in the event of a violent shock to the chest. Athletes are the most affected, like American football player Damar Hamlin.
Commotio cordis means “shock on the heart” in Latin. It is regularly observed in the world of sport, especially in football (American or not), baseball or hockey. In early 2023, Damar HamlinAmerican football player suffered a cardiac arrest by commotio cordis, without a history of cardiovascular disease.
What is the definition of a commotio cordis?
The commotio cordis is a rare cause of sudden death which occurs when a person receives a severe blow to the chest at a particular point in the cardiac cycle, during the repolarization phase, when the heart fills with blood. “It is time where the heart is most electrically vulnerablet. This shock to the chest induces an arrhythmia (rhythm disorder), specifically ventricular fibrillation, which leads to cardiac arrest in the absence of prior anomaly. Support is based on standard resuscitation techniques“says Dr. Claude Kouakam, cardiologist at the Heart Lung Institute of Lille University Hospital
Who is most at risk?
Anyone can be the victim of a commotio cordis in the event of a violent shock received in the chest. However, this phenomenon affects mostly athletes.
What causes a commotio cordis?
Commotio cordis is not a disease but a cardiac arrest which results from a violent shock received at chest level. “It is related to the fact that the blow is struck during the repolarization phase of the heart, during which the heart relaxes to fill up after having contracted to eject blood. The heart is quite “electrically vulnerable” during this phase of its cycle, and if a shock to the chest (direct or linked to a projectile), an extrasystole or other excite the heart muscle at that time, ventricular fibrillation can occur which can lead to spontaneous irreversible cardiac arrest.develops the cardiologist.
Which athletes are most at risk?
Commotio cordis affects contact sports and violent sports in which blows and other violent shocks related to projectiles are likely to occur quickly, such as:
- Rugby
- Boxing
- mma
- Soccer
- Baseball
- Hockey…
What are the warning signs?
The commotio cordis does not cause warning signs. It can occur in any individual with no known heart abnormalities. Concretely, the subject receives a blow at the level of the rib cage, collapses and has a cardiac arrest.
What support in case of commotio cordis?
“The management is the same as for a cardiac arrest having another origin. It is based on conventional resuscitation maneuvers, ideally defibrillation or cardiac massage. In the absence of resuscitation tools, it may be necessary to give a very powerful punch in the chest to perform a “reset” of the heart“, indicates the specialist.
What are the risks of complications? Deadly ?
In the absence of resuscitation, the commotio cordis can lead to death. “In the event of recovery, there is no evidence of an increased risk of recurrence or subsequent rhythmic events. And there is no “theoretical” contraindication to resuming sport or any indication for the implantation of a defibrillatorexcept in the event of a risky pathology requiring it“, adds Dr. Claude Kouakam.
Thanks to Dr Claude Kouakam, cardiologist at the Heart Lung Institute of Lille University Hospital