Atrial Fibrillation Induced From Commotio Cordis.

CASE: A 20-year-old male collegiate basketball player was evaluated for sudden chest pain, shortness of breath, dizziness, and blurry vision, following an elbow to the anterior chest by another player. His symptoms improved over 10 minutes of observation, but rhythm strip performed onsite showed atrial fibrillation, and the athlete was transmitted to the emergency department for further evaluation. Electrocardiogram in the ER confirmed atrial fibrillation with a rate of 85 bpm. Electrocardioversion was being arranged when he spontaneously converted to normal sinus rhythm, 2.5 hours from the traumatic event. CONCLUSIONS: Our case illustrates an unusual example of atrial fibrillation induced by commotio cordis (AFCC). Although less acutely life threatening and much less frequently described than ventricular fibrillation induced by commotio cordis, AFCC should be considered in the differential after blunt chest wall trauma. Currently, there are little data regarding management of patients with AFCC.

Diagnostic Criteria for Commotio Cordis Caused by Violent Attack: Review of the Literature.

The diagnosis of lethal commotio cordis (CC) is really complex. The forensic pathologist's task is even more relevant when he/she has to explain a CC diagnosis caused by an assault in a trial. The purpose of this study was to analyze the literature on lethal CC as a result of violent attacks and identify relevant parameters that may help in the diagnosis. A review of the relevant articles was performed. Fifty-two cases of CC caused by violent attacks were identified. The collected data allowed to confirm the following literature's criteria for CC diagnosis in case of assaults: witnessed occurrence of a blunt, nonpenetrating blow to the chest preceding cardiovascular collapse; absence of structural damage to the sternum, ribs, or heart itself; and absence of any underlying cardiovascular abnormalities (such as other causes of sudden death). Regarding the assessment of the third criterion, the authors suggest that the pathologist should always specify the scientific autopsy guidelines that he/she used to differentiate CC from the other causes of sudden death. In addition, the authors highlight the importance of a multidisciplinary approach for a correct interpretation of clinical, autopsy, and laboratory findings.

Forensic Pathological Identification and Antidiastole of Commotio Cordis.

Commotio cordis （CC） is the acute death caused by the cardiac rhythm disorder after a sudden blunt external force to the precordium of a healthy person without previous heart disease. As one type of violent heart damage, CC is rare with relatively small external force and sudden death, therefore causing disputes. This paper reviews the epidemiology, mechanisms and the key points in forensic identification of CC, discusses the identification and antidiastole of CC, myocardial contusion, sudden cardiac death and death from inhibition, and provides assistance to forensic pathologists to identify such causes of death.

Commotio Cordis and complete heart block: Where is the block level?

Ventricular fibrillation is typically the initial arrhythmia in commotio cordis following precordium impacts that occur within an electrically vulnerable period of the cardiac cycle. Conversely, complete heart block is very rare in this context, and its mechanism and temporal course are poorly understood. The presented case concerns a 12-year-old boy, athletic skier, who developed a transient complete heart block following commotio cordis. The electrocardiographic features, the proposed block level and mechanisms of complete heart block following commotio cordis are discussed.

Ventricular Tachycardia: A Rare Commotio Cordis Presentation.

Commotio cordis is a rare event caused by an unfortunately timed blunt anterior chest wall impact that most commonly presents in young male adolescents and is the second leading cause of death in young athletes. The most common initial presenting dysrhythmias are ventricular fibrillation and asystole, although other rare dysrhythmias have been reported-predominantly in animal models. To our knowledge, this is the first telemetry-confirmed case of commotio cordis with a presenting cardiac rhythm of ventricular tachycardia. While prompt recognition of commotio cordis and early cardiopulmonary resuscitation and defibrillation (if applicable) are still the treatment in these cases, our case offers potential insight into the underlying commotio cordis process.

Development of the NOCSAE Standard to Reduce the Risk of Commotio Cordis.

BACKGROUND: Commotio cordis, sudden cardiac death (SCD) caused by relatively innocent impact to the chest, is one of the leading causes of SCD in sports. Commercial chest protectors have not been demonstrated to mitigate the risk of these SCDs. METHODS: To develop a standard to assess chest protectors, 4 phases occurred. A physiological commotio cordis model was utilized to assess variables that predicted for SCD. Next, a surrogate model was developed based on data from the physiological model, and the attenuation in risk was assessed. In the third phase, this model was calibrated and validated. Finally, National Operating Committee on Standards for Athletic Equipment adopted the standard and had an open review process with revision of the standard over 3 years. RESULTS: Of all variables, impact force was the most robust at predicting SCD. Chest wall protectors which could reduce the force of impact to under thresholds were predicted to reduce the risk of SCD. The correlation between the experimental model and the mechanical surrogate ranged from 0.783 with a lacrosse ball at 30 mph to 0.898 with a baseball at 50 mph. The standard was licensed to National Operating Committee on Standards for Athletic Equipment which initially adopted the standard in January 2018, and finalized in July 2021. CONCLUSIONS: An effective mechanical surrogate based on physiological data from a well-established model of commotio cordis predicts the reduction in SCD with chest protectors. A greater reduction in force provides a great degree of protection from commotio cordis. This new National Operating Committee on Standards for Athletic Equipment standard for chest protectors should result in a significant reduction in the risk of commotio cordis on the playing field.

Commotio Cordis in 2023.

Since the nationally televised cardiac arrest of American National Football League player Damar Hamlin in January 2023, commotio cordis has come to the forefront of public attention. Commotio cordis is defined as sudden cardiac arrest due to direct trauma to the precordium resulting in ventricular fibrillation or ventricular tachycardia. While the precise incidence of commotio cordis is not known due to a lack of standardized, mandated reporting, it is the third most common cause of sudden cardiac death in young athletes, with more than 75% of cases occurring during organized and recreational sporting events. Given that survival is closely tied to how quickly victims receive cardiopulmonary resuscitation and defibrillation, it is crucial to raise awareness of commotio cordis so that athletic trainers, coaches, team physicians, and emergency medical personnel can rapidly diagnose and treat this often-fatal condition. Broader distribution of automated external defibrillators in sporting facilities as well as increased presence of medical personnel during sporting events would also likely lead to higher survival rates.

Commotio cordis (cardiac concussion) in a child. A case report. / Commotio cordis (conmoción cardíaca) en un niño. Reporte de un caso.

Commotio cordis or cardiac concussion is a rare and fatal mechano-electric arrhythmogenic syndrome. It is the second most common cause of sudden cardiac death in young athletes. It is most commonly associated with a sports-related injury, wherein, there is a high-velocity impact between a projectile and the precordium, causing arrhythmia that leads to the immediate death of the individual without cardiac resuscitation. On autopsy, the heart is structurally normal. With increasing awareness of this condition and community training in cardiopulmonary resuscitation, survival rates have been improving. The objective of this study is to describe the case of a patient who arrived at our hospital with commotio cordis and his course, emphasizing the importance of prevention and training of the population in cardiopulmonary resuscitation techniques and the use of the automated external defibrillator for the survival of patients suffering from commotio cordis.

Commotio cordis o conmoción cardíaca es un síndrome arritmogénico mecano-eléctrico raro y mortal. Es la segunda causa de muerte súbita en atletas jóvenes. Se asocia con una lesión que se produce durante la práctica deportiva, en la que un proyectil impacta a alta velocidad en el precordio y provoca una arritmia que conduce a la muerte inmediata del individuo sin una reanimación cardíaca. En las autopsias, los corazones son estructuralmente sanos. Con el conocimiento de este síndrome y las capacitaciones de reanimación cardiorrespiratoria a la comunidad, las tasas de supervivencia han mejorado. El objetivo de este trabajo es describir un paciente que llegó a nuestro hospital con conmotio cordis y su evolución, enfatizando la importancia de medidas de prevención y capacitación de la población en técnicas de reanimación cardiopulmonar y uso del desfibrilador externo automático para la supervivencia de los pacientes que sufren esta entidad.

Complete heart block following a blow on the chest by a soccer ball: a rare manifestation of commotio cordis.

Commotio cordis is a rare type of blunt cardiac injury in which low impact chest trauma causes sudden cardiac arrest, usually occurs from being struck by a projectile during sports. The most common arrhythmia during commotio cordis is ventricular fibrillation, although complete heart block and an idioventricular rhythm have also been reported. We describe a case of a young patient who presented with a persistent third-degree atrioventricular block and a left bundle branch block, following blunt chest trauma, as a result of blow by soccer ball and subsequently needed a permanent pacemaker.

Imprudent blow, catastrophic consequence: a case of commotio cordis associated with violence.

Commotio cordis is a rare and catastrophic mechano-electric feedback syndrome, and it is especially apt to occur in male children, adolescents and youths during sports activities. The authors present a case of unexpected sudden death due to commotio cordis associated with violence. In a house of detention, a 19-year-old boy was punched and kicked in the face, neck and chest during a fight with another suspect in their ward. Unfortunately, his precordium was the major injured region. The victim turned pale, then lost the ability to resist and lost consciousness immediately. When the emergency medical personnel arrived, the victim was found in a condition of cardiac and respiratory arrest and he was pronounced dead at the scene without cardiopulmonary resuscitation. Both autopsy signs and forensic morphology were in accord with the criteria for commotio cordis diagnosis, showing no cardiac or other organic fatal lesions and no underlying cardiac diseases; moreover, the toxicological screening was negative for alcohol, drug and common toxicants. In the present case, the whole fight was seen by some witnesses in their ward, and it was recorded by the monitoring unit. Based on the statements of the witnesses and the monitoring videotape, combined with the forensic pathological and toxicological examinations, all the testimonies supported the conclusion that the cause of death was commotio cordis.

Commotio cordis - under-recognized in Europe?: a case report and review.

This case and the review illustrate the induction of a sudden collapse of a football player secondary to a blow to his chest (commotio cordis) [CC]. The article argues that CC probably is under recognized in Europe and cautions that the mounting intensity and speed inherent in modern sports possibly increase the likeliness of CC in the future. If CC occurs, immediate cardiopulmonary resuscitation and automatic external defibrillator should be used.

Commotio Cordis presenting as a temporary complete atrioventricular block in a 2-year-old girl with congenitally corrected transposition of the great arteries.

This report describes a 2-year-old girl with congenitally corrected transposition of the great arteries (ccTGA) who presented with transient complete atrioventricular (AV) block after a mild chest blow. Running around the house with her older sister, she fell to the floor. Her sister also fell and landed on her. The girl became cyanotic and pale and experienced a transient loss of consciousness. At arrival to the emergency department, she had regained consciousness, but she remained pale. An electrocardiogram (ECG) demonstrated complete AV block with a heart rate of 78 beats per minute (bpm). The ECG after admission showed a Wenckebach-type second-degree AV block. Day 2 after admission, a 12-lead ECG showed significant ST and T-wave abnormalities in the precordial leads, but the girl had no chest pain and a normal physical examination. Echocardiography demonstrated normal contractility of the systemic right ventricle. The first-degree AV block and the ST and T-wave abnormalities on the 12-lead ECG improved gradually without abnormal Q-waves. This is the first report of ccTGA in which a transient complete AV block naturally recovered after a presentation with commotio cordis.

Commotio Cordis Resulting from Sibling Rivalry.

A 17-year-old girl with no significant medical, surgical, or family history presented to the emergency department following an episode of sudden cardiac arrest after being punched in the chest by her brother. Bystander CPR was immediately initiated, and she was found to be in ventricular fibrillation by emergency services. The patient had return of spontaneous circulation after one defibrillation event. No other significant injuries were found, and she eventually experienced a complete neurologic recovery and was discharged with no other identified cause for her arrest. The objective of this clinical case report is to highlight this unusual and rare injury to increase awareness and avoid incorrect diagnosis.

Don't Forget Commotio Cordis.

Non-penetrating chest blows can occasionally trigger fatal ventricular tachyarrhythmias and sudden death (commotio cordis). Such events were initially reported in association with sporting activities and projectiles such as baseball/lacrosse balls. However, similar potentially fatal chest blows, seemingly incapable of causing death, can occur during a variety of other circumstances such as when delivered during a fight (by a fist) such as in the accompanying paper. Notably, commotio cordis events can be reversed by resuscitation and defibrillation.

Commotio cordis as a rare cause of traumatic cardiac arrest in motorbike crashes: Report of a case.

It is futile to attempt resuscitation in a blunt injury patient with no vital signs upon arriving at the emergency department. Therefore, it is recommended that resuscitation be withheld in any blunt trauma patient without vital signs while emergency medical technicians arrive at the scene of the accident. This report presents a case of a blunt torso trauma patient who lost vital signs at the scene and still received cardiopulmonary resuscitation until recovery of spontaneous circulation at the emergency department. The patient was later diagnosed with commotio cordis, and survived to be discharged without any neurological sequelae. Therefore, aggressive resuscitation should be continued until a diagnosis and differential diagnosis of blunt trauma-related cardiac arrest are made by a thorough examination in the emergency department.

The role of the autopsy in the diagnosis of commotio cordis lethal cases: Review of the literature.

Commotio Cordis (CC) diagnosis is based on the occurrence of a blunt, non-penetrating blow to the chest preceding cardiovascular collapse and the absence of structural damage that would explain any observed effects. In CC lethal cases, the execution of the autopsy represents a possible diagnostic tool. Nevertheless, to date in the literature no author expresses an opinion about the use of the autopsy. In the light of the above, the authors propose a review of the literature about this topic. The review consents to state that the occurrence of a blunt blow to the chest is a necessary element for a lethal CC diagnosis, but it cannot be considered enough. Indeed, because CC is a recognized cause of sudden cardiac death, the autopsy should be always performed to exclude the presence of structural damage that would explain any observed effects. This approach is fundamental in order to achieve an accurate diagnosis and to distinguish CC from other causes of sudden cardiac death. In addition, the authors sustain that in case of autopsy data's lack the authors should not identify CC diagnosis as definitive but as possible.