Commotio cordis as cause of sudden cardiac death associated with chest trauma

Abstract

The review describes a rarely occurring state of commotio cordis (CC) — ventricular fibrillation (VF), associated with unintentional blunt impact on the anterior thoracic wall in the absence of structural damage to the heart. The development of VF is based on the coincidence of the time of a closed breast trauma with a vulnerable period during early repolarization (the so-called "vulnerability window"). More often, death occurs instantly or in the coming minutes of a post-traumatic period. CC is more common in male adolescents and seems to be the second leading cause of sudden death in young athletes. It is possible to save the victim with cardiorespiratory resuscitation or defibrillation only in 25–28 % of cases. High mortality is explained by the fact that victims often do not have time to receive immediate medical care. It is necessary to inform the population, medical community and athletes about importance to avoid hitting the heart. As a preventive measure in some sports, chest protectors are used. Information about the potential danger of blows to the heart area should be provided to the attention of athletes involved, since even an unintentional mild blow can provoke a life-threatening arrhythmia. Having access to defibrillators at sporting events, teaching people to use them and to realize the cardio-pulmonary resuscitation measures can improve the survival of the CC victims.