Blunt Chest Trauma – Commotio cordis
Commotio cordis (disturbance of the heart) is a descriptive term meaning cardiac arrest associated with low-impact blunt trauma to the anterior chest, usually by a relatively low-velocity missile, such as a baseball, cricket ball or hockey puck, or by a blow delivered by a fist, foot, elbow, or knee during sporting activities. It is not associated with any structural damage to the ribs, sternum or heart, which is otherwise known as contusio cordis. It is usually associated with sudden death in children.However, arrhythmias may also be observed in these patients instead of commotio cordis. Conduction abnormalities and ventricular arrhythmias such as ventricular tachycardia and fibrillation have been reported due to chest traumas. For an arrhythmia otherwise considered idiopathic, it is also novel in its clear association with a triggering factor, that is, blunt thoracic trauma. In these
arrhythmias, the mechanism of onset of ventricular fibrillation from a blow to the chest is well known. In an animal model, a blow falling during the vulnerable period before the T-wave peak results in a rapid rise in left ventricular pressure with likely activation of ion channels via mechanoelectric
coupling, leading to premature ventricular depolarization and ventricular fibrillation.
In commotio cordis victims, the chest blows usually strike the left chest. Most of these blows reportedly occur directly over the cardiac silhouette; however, the exact location of the chest wall strike cannot always be determined with precision.The spectrum of injuries to the heart includes damage to the great vessels, myocardial rupture or contusion, hemopericardium, poor contractility, and valvular disruption.Today, chest barriers are commonly used to protect children from the chest blows.
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