Commotio cordis: sudden death due to chest wall impact in sports

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Abstract
Human victims of commotio cordis are young, healthy, and predominantly male.3 The victims have no known histories of heart disease or other chronic medical illnesses. The impacts occur on the chest wall directly overlying the heart, and the velocity of the impact is routine for the sport involved.3 Collapse is usually instantaneous, but occasional brief moments of lucidity in which the victim complains of lightheadedness have also been described. Ventricular fibrillation is the most common initial rhythm documented; however, heart block, accelerated idioventricular rhythm, and asystole have also been seen.1-7 Resuscitation is more difficult than would be expected, especially as the athletes do not have cardiac disease and there are often immediate resuscitative efforts.3 , 8 Necropsy reveals no thoracic or cardiac abnormalities. In these unfortunate victims, the most widely believed mechanism of sudden death is ventricular fibrillation resulting from impact during a vulnerable period of the cardiac cycle.3Other proposed causes are complete heart block, a pronounced vagal response, and electromechanical dissociation.9

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