Commotio Cordis is not a disease. Rather, it is a complication of a fatal arrhythmia that occurs accidentally in an individual with no known pre-existing heart defect of any kind.
The name Commotio Cordis translates from Latin and means "agitation of the heart", in connection with the sudden destabilization of the synchronization of the heart's electrical system. The electricity becomes anarchic and, as a result, the heart muscle no longer contracts efficiently. The heart wiggles like gelatin being shaken. It is called ventricular fibrillation, a lethal arrhythmia.
A Long-known Phenomenon
This tragic event and its consequences have been described in the medical literature for over 120 years. Current statistics indicate that fewer than 20 cases are reported each year in the United States.
It occurs almost exclusively in teenagers with an average age of 15 years, most often in competitive or team sports such as Little League Baseball in the United States. The incidence is lower in young people who participate in martial arts or other contact sports.
For a commotio cordis to occur, there must be a combination of very specific conditions. They are as follows:
- a precise blow to the front part of the rib cage;
- the shock must be powerful but without causing a sternal or costal fracture;
- the blow must occur at a particular moment in the electrical cycle of the heart, that is to say immediately after a heartbeat.
Chest impact before the loss of consciousness puts sudden syncope secondary to underlying heart disease during sports activity. However, a diagnosis of commotio cordis will only be made after other possible causes have been ruled out.
Certain characteristics such as flexibility of the rib cage in early life and genetic susceptibility have been identified.
However, another element is questioned. The focus on males only may be because fewer adolescent females engaged in sports identified with commotio cordis in earlier years.
The clinical presentation is a syncope that knocks the person to the ground a few seconds after the impact to the chest.
The victim is unconscious, has noisy breathing, may have body rigidity, and then nothing; this is called "sudden death".
A Life-saving Discovery
Ventricular fibrillation haunted cardiology and cardiac surgery for many years. Up until recent years, there was no treatment for lethal arrhythmias.
The arrival of the cardiac defibrillator, delivering an electric shock to the heart, allows the resetting of a synchronized sequence of its electrical system with the restoration of an effective cardiac contraction. The heart pump then resumes its function of circulating blood efficiently.
A Defibrillator is Essential
A defibrillator is “THE” treatment for commotio cordis. The device must be used as rapidly as possible so as to avoid irreversible neurological consequences secondary to cerebral anoxia, namely, the lack of oxygen to the brain.
Impact on Survival
Chances of survival are doubled with rapid cardiopulmonary resuscitation (CPR) and immediate access and use of a automated external defibrillator (AED). This type of defibrillator is now readily available in almost all public locations. They are present in almost all public places and undeniably simple to operate. By way of proof, 10-year-old children can handle one easily and successfully.
It is most important for the location of these devices to be clearly indicated in public areas, much like the way emergency exits are identified.
Cardiac Arrest Due to Torsade de Pointes
Some cases are designated commotio cordis spontaneously aborted with a recovery of consciousness. The arrhythmia being referred to here is rather an amorphous ventricular tachycardia or a torsade de pointes (twisting of points).
Torsade de Pointes refers to a heart rate that is too fast to maintain adequate blood pressure for brain oxygenation. This can stop on its own, allowing the heart rate to return to normal.
Mechanisms leading to ventricular fibrillation after a thoracic impact are complicated, For the purpose of this article, it should be noted that they relate to the electrical charges of cardiac cells.
The treatment starts with CPR and the return to a normal heart rate. What happens next will depend on the victim’s state of consciousness.
If the person remains unconscious, then ventilatory support is necessary with the help of an artificial respirator.
Brain damage due to lack of oxygen is the most feared condition in this context. Pharmacological measures are often necessary to bring the brain to complete rest in order to relieve the organ that may have been injured. This induced coma is called “artificial coma”.
This investigation aims at making sure all cardiac structures are perfectly normal.
An echocardiogram, coronary artery imaging, cardiac magnetic resonance, and cardiac electricity studies are usually performed.
This depends primarily on the cerebral damage that was endured. In this instance, it is always difficult to decide what may happen in the future. The prognosis is excellent if no damage was done.
The absence of brain activity, after an artificial coma caused by drugs, signals the end of any hope of survival.