Commotio Cordis: A Rare but Dangerous Condition

The recent sudden cardiac arrest of a young professional football player has brought attention to a heart condition called commotio cordis. Although commotio cordis has not been definitively identified in this case, many cardiologists and experts suspect it may have been the cause of the athlete’s cardiac arrest on the field. 

Commotio cordis is a heart condition in which an object striking the chest at just the right time can cause sudden cardiac arrest. This has happened in athletes in the past when struck with hockey pucks, baseballs, or tennis balls as well.

What’s the physiology of commotio cordis?

A heartbeat is formed when different parts of the heart contract in a rhythm guided by the sinus node. As each part of the heart contracts in coordination with the others, blood is pumped through the heart’s chambers. If the heart is struck hard enough when the lower chambers, or ventricles, are supposed to be resting, it can cause them to contract. This creates a ventricular fibrillation and sudden cardiac arrest. Sudden cardiac arrest is the sudden loss of all cardiac function and activity. Breathing stops, and if not treated swiftly, sudden cardiac arrest is fatal.

Commotio cordis is known as a diagnosis of exclusion. When a person experiences sudden cardiac arrest after being struck in the chest, doctors will evaluate more common causes of cardiac arrest to rule them out. When no other cause can be found, commotio cordis is confirmed.

What are the chances of commotio cordis? 

Commotio cordis is an extremely rare condition. It is believed there are only about 30 cases of commotio cordis annually. It happens most often to people who fit these categories:

• Male
• Younger than 20
• Athletes, particularly if the sport involves balls, pucks, or other hard objects 

Can people survive commotio cordis?

People can and have survived commotio cordis, though survival depends on immediate medical care. Survival rates historically have been very low, but awareness, early recognition, and availability of treatment have increased survival rates. 

Surviving commotio cordis requires immediate CPR and the use of an AED (automatic external defibrillator) to restore normal heart rhythm. As the availability of AED machines and awareness of the condition have increased, some individuals have received treatment more rapidly. Though protective equipment does not completely prevent commotio cordis, it can decrease the risk. 

If you witness a sudden collapse after a person is struck in the chest with a hard object, be sure to call 911 and administer CPR until an AED can be used and/or medical help arrives.