Review Question - QID 211821

Early defibrillation increases survival in commotio cordis.

Commotio cordis is a rare condition resulting from a direct blow to the precordium during ventricular repolarization (less than 1% of the cardiac cycle). Adolescent males appear most at risk, with the average victim age being 15. Immediate cardiac defibrillation is linked to increased survival. Chest pads have not been shown to prevent this condition from occurring. However, educating coaches, athletes, and trainers on this condition and having access to a defibrillator may improve survival.

De Gregorio et al. reviewed the modern management of blunt thoracic trauma and cardiac injury in athletes. They report that projectiles such as baseballs and hockey pucks are responsible for a majority of these cases. Ventricular fibrillation is the most common initial rhythm leading to asystole if not quickly defibrillated.

Weinstock et al. performed an experiment to evaluate the effectiveness of commercially-available chest wall protectors in preventing commotio cordis. They used a swine model to test 12 different chest protectors subjected to a 40-mph precordial blow (compared to a control group without chest protectors) with lacrosse balls and baseballs during the ventricular repolarization period. They concluded that the chest protectors were ineffective in protecting the animal model from commotio cordis.

Illustration A is a cartoon showing the mechanism of commotio cordis.

Incorrect Answers:
Answer 1: This describes sudden cardiac death due to hypertrophic obstructive cardiomyopathy (HOCM).
Answer 3: Physical exam cannot detect individuals susceptible to commotio cordis (the same is not true for HOCM).
Answer 4: There has never been evidence of structural damage to the heart found at autopsy in patients with commotio cordis.
Answer 5: The impact occurs during ventricular repolarization (upstroke of the T-wave).