Ever heard of Commotio Cordis?
is from the result of a blow to the chest at a critical time at a precise
millisecond between heart contractions that throws the heart into lethal
ventricular fibrillation(VF). It is not of the force of the blow and causes
no identifiable structural injury to the ribs, sternum or to the heart
actual number every year is really unknown since many are misdiagnosed. One
estimate was 62/yr. It occurs during several different sports and
activities. One list reported having 53=Baseball, 14=Softball, 10=Hockey
pucks, 8=Fists and boxing, 5=Knee or foot, 5=Elbows, 5=Lacross balls,
5=Parent Disciplining Child, 4=Shoulder, 2=Cricket balls, 2=Football
helmet. As you can see most are from baseball and even very slow speed
balls can cause it. The chest protectors do not prevent this.
Survival after a commotio cordis event has increased over the
years from when there was 5% survival. Survival has usually been associated
with effective and timely CPR efforts and defibrillation that occur within 3
minutes of the collapse. Current estimates are 70-90% survival. Although
efforts at resuscitation occur frequently, the onset of CPR is often delayed
because observers underestimate the severity of the trauma or condition. The
survival rate is only 5% or less in cases in which resuscitative efforts
were delayed longer than 3 minutes.
most common cause of sudden death in athletes is hypertrophic
cardiomyopathy. It is a heart condition of very thick wall muscle of the
heart. Again there are not accurate estimates but it is uncommon … one in
5,000?? Many have no symptoms before cardiac arrest but some have irregular
heart beats or passing out while exercising/running. The doctor’s physical
exam can pick up maybe around 10% who are likely to have this condition. An
ECG picks up around 90%. (More accurate than us.) Europe has been screening
teenagers for many years and the incidence has greatly decreased there.
America does not recommend screening them here because of cost and the
rareness of the condition. Cook Children’s cardiology performs the sports
ECG for $25. That is like going out to eat now days. So I ask the parents
to get the sport’s ECG done around 12 years old.
So for both of these conditions it is critical to act
IMMEDIATELY with CPR and AED shock. You can also first slap the chest hard
with the palm of your hand and deliver a shock that can restart the heart
rhythm. Can’t hurt to do that as you start CPR and run for the AED. This
is rare! You probably won’t need this information. But many new parents
learn CPR just in case. Please don’t worry about your child but it is nice
to know this information.
Here are some examples:
Saved by AED
Implanted defibrillator saves soccer player.
Roger Knapp MD