Commotio cordis: Are we aware?

Instantaneous death after a relatively minor hit on the precordium is known as commotio cordis (CC). Mechanical stimulation of the heart by a nonpenetrating, impulse-like impact is sufficient to induce ventricular fibrillation (VF) in an otherwise normal heart, but not forceful enough to make structural damage to the myocardium or the thoracic cage. It is second to hypertrophic cardiomyopathy as a cause of sudden death in young individuals engaged in sport. When the blow on the chest coincide with the vulnerable period in the cardiac cycle produce a phenomenon similar to ‘R on P’ in premature ventricular complexes (PVC) resulting in VF. Two thirds of the events are sports related. Timing of the impact, hardness and speed of the projectile plays an important role in the pathophysiology of CC. Higher velocity projectiles may produce more severe injury resulting in tissue trauma but not CC. The site of impact on the chest is also crucial. It is the portion ofthe chestwall exactly overlying the letventricle on the left of sternum which has to be struck to produce CC. Training persons involved in sports related activities in cardiopulmonary resuscitation and making defibrillators immediately available may prevent some deaths related to CC. Designing softer balls and protective devices may prevent although not eliminate CC.