Ever heard of commotio cordis? Key points on this rare cause of cardiac arrest

This is a rare occurrence that results in cardiac arrest in which there is sudden arrhythmic death.

It triggers an abnormality in the rhythm of the heart.

It is characterized by a typical strong blow to the chest.

Read this article to understand more on commotio cordis and who is at higher risk.

"This refers to sudden cardiac death after a relatively low-impact blunt trauma to the anterior chest wall. It generally happens while playing football, hockey, baseball, cricket etc.," says Dr. Bharat Vijay Purohit, Sr. Consultant Interventional Cardiologist & Director of Cath Lab, Yashoda hospitals, Hyderabad.

"It generally affects young athletes below 20 year age and is very rarely seen in those older than 25 year," he adds.

This is sudden cardiac death in young people usually occurs due to underlying structural and electrical conduction abnormalities like coronary artery anomalies, hypertrophic heart, cardiomyopathies, and conduction disturbances like Long QT Syndrome (LQTS), Short QT Syndrome, or Catecholaminergic polymorphic ventricular tachycardia (CPVT), explains Dr Lal Daga, Senior Interventional Cardiologist, Apollo Hospitals, Ahmedabad.

Dr Daga says these patients usually show signs of unresponsiveness, apnea, pulselessness, and no audible heartbeat.

"It may also occur due to blunt trauma (Commotio Cordis) to the left precordial area or chest even without any underlying cardiac abnormalities. This usually occurs due to provoking ventricular fibrillation during ventricular repolarization," Dr Daga adds.

"It should not be confused with another term which also has similar presentation “contusio cordis”, where contusion of Heart muscle, or rupture of a cardiac chamber, or disruption of a heart valve may be caused by blunt trauma to the chest mostly due to motor vehicle accidents," Dr Purohit said.

The treatment for commotio cordis is in usual lines of resuscitation with CPR and prompt Defibrillation by Defibrillator machine or AED, says Dr Purohit. "defibrillation within 1 minute of ventricular fibrillation onset results in a 100% survival rate and that defibrillation after 2 minutes results in an 80% survival rate. every 1-minute delay in defibrillation beyond the first 3 minutes decreases the likelihood of survival by approximately 10%," he adds.

Dr Daga stresses on immediate medical help. "These patients not only need quick and prompt cardiopulmonary resuscitation to save the life of the patient but also need to be immediately shifted to a tertiary cardiac centre for further care. After emergency resuscitation further workup can be done," he says.

In view of the nature of the trauma that triggers this cardiac arrest event, Dr Purohit says, young people should use protective material like shields on their chest while playing sports in which there are chances of collision.

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