RT-221
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Clinical profile of commotio
cordis: a new cause of sudden death in the young during sporting activities
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Barry J. Maron.
Minneapolis Heart Institute Foundation, Minneapolis, USA
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Supported in part by a grant from the
National Operating Committee on Standards for Athletics Equipment (NOCSAE), 1996, Overland
Park, Kansas, USA.
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Abstract
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Sudden cardiac death in young athletes is usually due
to a variety of unsuspected congenital heart malformations. Less well recognized are
athletic field catastrophes in which cardiac arrest is produced by blunt blows delivered
directly to the chest, in the absence of morphologic injury to the sternum, ribs or heart
(commotio cordis). To characterize the clinical profile of this syndrome we have now
assembled 58 cases, including 29 occurring during organized competitive athletics and 29
others during informal recreational sports activity at home, school or playground. Ages
were 1 to 25 (mean 11) with 80% < 16 years old. Most common sports were youth baseball
(n = 38), softball (n = 7), and ice hockey (n = 5). Chest blows were produced in 49 (85%)
by a projectile that was part of the game itself such as baseballs or hockey pucks; the
other 9 (15%) did not involve a projectile, but were the results of broad surface bodily
contact with the victim's chest, such as a collision with a teammate or karate kick. Five
of the 58 commotio cordis victims (9%) survived their cardiac arrest; in 4 of these 5
survivors cardiopulmonary resuscitation by bystanders was particularly prompt (<
1 minute). Nine sudden cardiac deaths (15%) occurred despite the presence of chest padding
while in the other 49 the precordium was completely unprotected. The commotio cordis
syndrome: 1) accounts for an important subset of sudden deaths during sports activities;
2) is due to chest blows that do not appear unusual or of sufficient magnitude to result
in cardiac arrest; 3) is not uniformly fatal; and 4) appears to be due to ventricular
dysrhythmia initiated by chest impact at the electrically vulnerable period of
repolarization.
Greater recognition of commotio cordis is critical to creating an informed public,
formulating preventive measures to enhance the safety of athletic competition, and
increasing the liklihood that resuscitation measures will be initiated promptly, thereby
advancing the possibility of survival.
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Key Words
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Arrhythmias in athletes
sudden death, commotio cordis syndome, blunt chest blow, ventricular disrhythmia,
electrical vulnerable period of repolarization, preventive measures, cardiopulmonary
resuscitation measures, systemic sports training/competition, OA
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