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Commotio Cordis / Sudden Cardiac Arrest

 

synonyms:SCA, Commotio Cordis / Sudden Cardiac Arrest

Commotio Cordis ICD-9

Commotio Cordis Etiology / Epidemiology / Natural History

  • Commotio Cordis = Ventricular arrhymias (generally V. Fib) from sudden, blunt, low-impact force to the chest without apparent heart injury.
  • Generally young males involved in ball related sports (baseball).
  • Survival rates are low (10%). (Maron BJ, Am J Cardiol. 1997;15:840).
  • @ 2-4 deaths per year in baseball (Janda DH, Clin J Sports Med 1992;2:172)..
  • Sudden cardiac arrest accounts for @115 deaths/yr in the US.

Commotio Cordis Clinical Evaluation

  • Pulseless with no breath sounds after blunt trauma to chest wall.
  • Hypertrophic Cardiomyopathy (HCM): accounts for 50% of cases of sudden cardiac death in young athletes. HCM should be considered in any adolescent athlete with a left ventricular wall thickness of 12mm in males (11mm in females) and a nondilated ventricle (<48mm). HCM is an absolute contraindication for vigorous exercise. (Sharma S, J Am College Cardiol 2002;40:1431).

Commotio Cordis Classification / Treatment

  • Immediate institution of cardiopulmonary resuscitation and activation of EMS.
  • Early defibrillation (AED) for ventricular fibrillation may improve survival. Precordial thump if defibrillation unavailable
  • SCA consensus statement.

Commotio Cordis Complications

  • Death

Commotio Cordis Follow-up Care

  • Emergent transfer to hospital.

Commotio Cordis Review References

  • Demorest RA, OKU-Sports Medicine 3
  • www.nata.org (search for sudden cardiac arrest)
  • Denzer JA, J Athl Train. 2007;42:143
  • McCrory P, Br J Sports Med 2002;36:236
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