Saturday, June 4, 2011

What Is Commotio Cordis ?

This diagram will help to clarify the "risk window" in commotio cordis

What would be seen on 12lead EKG in impact which causes commotio cordis

Even a mild blow to the chest in sports or in play can precipitate commotio cordis

I realize that it's a difficult concept to grasp that a child or teen can be well one moment, without apparent illness and then in full cardiac arrest in another moment. It's a concept I have had trouble with, even when it happened here. I am still working on understanding this emotionally even two and a half years after our son Daniel's sudden passing.
In Daniel's case, the apparent cardiac arrest was spontaneous and without a specific identified causative factor. He appears simply to have experienced a heart rhythm disturbance which was incompatible with life. In Daniel's case, CPR and epinephrine injections were given by me, and ultimately and AED was used by the Sheriffs, but with no result whatsoever. A helicopter Medical ICU arrived soon after, and also could not restart Daniel's heart. It is theorized that Daniel's heart rhythm tripped into a probable "Torsade des Pointes" or twisting of the points, in which the electrical conduction system of the heart continues aimlessly without pumping, and almost always results in death, even when attended to immediately with CPR.

Daniel did not experience Commotio Cordis. There was no apparent soft or severe blow to the chest. Commotio cordis is a phenomenon in which the heart rhythm is significantly disrupted sufficiently to cause cardiac arrest, usually during sports, when an object hits or taps and area in the vicinity of the chest. Commotio cordis usually afflicts children or younger teens, the median age of 15, often boys. Being hit with a puck or ball, even lightly has caused a cardiac arrest, and interestingly, even when a chest protector was worn. Very simply put,during a normal heartbeat as traced by a normal EKG, the "P wave" represents the sinoatrial or SA node exerting an impulse to trigger a heartbeat. Then a "QRS complex) traces the beat through the remainder of the heart. Then and very importantly, the "T wave" traces the repolarization, rest period and readying for the beat to begin again. It is essential that the T wave occurs without interferences of any kind. To experience an "R on T phenomenon" is to experience a beat or tap in the chest or heart area during the T wave or "Essential repolarization" of the heart. This disruption of the cardiac rest period will cause a potentially lethal arrhythmia and potentially a cardiac standstill or arrest. Survival, even with rapidly administered CPR or with an AED handy, is only between about 30-35%. This is potentially possible not only in human beings but has been demonstrated in other mammals. This occurs more often during physical activity as a rapid heart makes the person more valuable, and seems to afflict more teens than adults, although this possible in all human beings.
I did give some consideration to commotio cordis is Daniel but only insofar as he had vomited just as, or just prior to experiencing cardiac arrest. Theoretically, vomiting reflexively during the T wave, could actually result in a de facto R on T phenomenon, insofar as it could disrupt the T wave and cause an arrest. The cause of Daniel's cardiac arrest though was a momentary consideration because the procedure to restart his heart would have been the same in that situation, regardless of the original cause.
I have described and discussed commotio cordis above because it has been in the news several times this year when young men from across the country have died following the familiar scenario. Also, I am getting a fair number of questions in the Hayden Walton case.
Hayden Walton, aged 13, experienced an apparent commotio cordis while playing baseball at the beginning of June. He apparently stepped forward to catch a bunt and received no more than a tap to the chest from the baseball. He made two steps afterward, and collapsed into a cardiac arrest. I would imagine that CPR was administered by either coaches, parents who were EMTs, physicians, nurses or CPR certified parents, but as is the case with so many of these situations, once a cardiac arrest secondary to commotio cordis occurs, restarting the heart can be difficult. According to news sources, both of Hayden's parents were present at the baseball game which ultimately took his life.
Once again, my family and I send prayers and condolences to any family who has experienced the loss of a child to commotio cordis or to any cardiac rhythm disturbance.
This may not be as rare an occurance as many of us believe. Although Daniel is believed to have passed as a result of a heart rhythm disturbance, it was not commotio cordis. Some of the kids who have died following commotio cordis are:

Thomas Adams age 16 New Jersey died January, 2011 baseball

Andrew Cohn age 15 Florida died June, 2010 baseball

Jaxon Logan age 18 Alaska died 2004 hockey

Louis Acompora age 14 died March 2000 lacrosse

Robbie Levine age 9 died Sept. 2005 baseball

George Boiardi age 21 (est.) died March 2004 lacrosse

Benoit Lebreaux age 36 Montreal P.Q, died June 2003 karate

Justin Saccone age 15 Ohio died Sept. 2003 baseball

and many others, about 200 since 1994, but this is believed to be unreported or reported as a death from other causes. At least now, commotio cordis deaths are being tallied.

More information on commotio cordis can be obtained by:

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