Commotio cordis - Revision history

Danbot: Add verified PubMed references (PMIDs 28587536, 37558288)

2026-03-22T10:59:10Z

Add verified PubMed references (PMIDs 28587536, 37558288)

← Revisión anterior		Revisión del 10:59 22 mar 2026
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	==Background==		==Background==
	*Sudden [[cardiac arrest]] from blunt, non-penetrating chest wall impact in the absence of underlying cardiac disease or structural damage		*Sudden [[cardiac arrest]] from blunt, non-penetrating chest wall impact in the absence of underlying cardiac disease or structural damage<ref>Menezes RG, et al. Commotio cordis: A review. Med Sci Law. 2017 Jul;57(3):146-151. PMID 28587536</ref>
	*50% of cases occur during competitive sports (baseball is most common)		*50% of cases occur during competitive sports (baseball is most common)
	*Most commonly affects young males (median age 14)		*Most commonly affects young males (median age 14)<ref>Lee RN, et al. Commotio Cordis in Non-Sport-Related Events: A Systematic Review. JACC Clin Electrophysiol. 2023 Aug;9(8 Pt 1):1321-1329. PMID 37558288</ref>
	*Autopsy shows structurally normal heart with no myocardial contusion, rib fracture, or other thoracic injury		*Autopsy shows structurally normal heart with no myocardial contusion, rib fracture, or other thoracic injury

Danbot: Expand with concise EM-focused content: pathophysiology risk factors, post-ROSC workup, prevention

2026-03-21T01:21:23Z

Expand with concise EM-focused content: pathophysiology risk factors, post-ROSC workup, prevention

← Revisión anterior		Revisión del 01:21 21 mar 2026
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	==Background==		==Background==
	*Sudden cardiac arrest ~~resulting~~ from blunt chest ~~trauma~~ in absence of underlying cardiac disease~~<ref name="Yousef">Yousef R, Carr JA. Blunt cardiac trauma: a review of the current knowledge and management. Ann Thorac Surg. 2014 Sep;98(3):1134-40. doi: 10.1016/j.athoracsur.2014.04.043.</ref>~~		*Sudden [[cardiac arrest]] from blunt, non-penetrating chest wall impact in the absence of underlying cardiac disease or structural damage
	*50% of cases ~~due to~~ competitive sports~~<ref name="Yousef" />~~		*50% of cases occur during competitive sports (baseball is most common)
	**Baseball is most common ~~culprit~~		*Most commonly affects young males (median age 14)
	*Autopsy ~~usually~~ shows normal ~~cardiac anatomy~~ with no ~~evidence of damage to heart~~ or other intrathoracic structures<ref name="Ngai">Ngai KY, Chan HY, Ng F. A patient with commotio cordis successfully resuscitated by bystander cardiopulmonary resuscitation and automated external defibrillator. Hong Kong Med J. 2010 Oct;16(5):403-5.</ref>		*Autopsy shows structurally normal heart with no myocardial contusion, rib fracture, or other thoracic injury

	{{Background BCI}}		{{Background BCI}}

	===Pathophysiology~~<ref name="Ngai" />~~===		===Pathophysiology===
	*Primary electrical event ~~resulting in induction~~ of [[~~Ventricular Fibrillation~~]]		*Primary electrical event: blow to precordium during the vulnerable period of repolarization (10-30 ms before T-wave peak) triggers [[ventricular fibrillation]]
	*~~Likely due to blow occurring 10-30ms before peak of T wave, although this theory is disputed<ref name="Yousef" />~~		*Risk factors for commotio cordis:
	*~~Strike~~ directly over cardiac silhouette ~~↑ risk of developing commotio cordis~~		**Impact directly over the cardiac silhouette
	*~~Younger patients more at risk -~~ compliant chest wall ~~allows transmission of~~ more energy ~~to the heart.~~		**Young, compliant chest wall (transmits more energy)
			**Velocity of projectile 30-50 mph (neither too slow nor too fast)
			**Small, hard projectile (baseball, hockey puck, lacrosse ball)

	==Clinical Features==		==Clinical Features==
	*[[Cardiac arrest]] (usually [[ventricular fibrillation]])		*Witnessed collapse immediately after chest wall impact
			*[[Cardiac arrest]] — usually [[ventricular fibrillation]]
			*No external signs of significant chest wall injury

	==Differential Diagnosis==		==Differential Diagnosis==
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	==Evaluation==		==Evaluation==
	*Clinical		*Clinical diagnosis based on witnessed event and mechanism
			*Post-resuscitation workup if ROSC achieved:
			**[[ECG]]: may show ST changes or arrhythmias
			**Troponin (to evaluate for myocardial injury)
			**[[Echocardiography]]: should be structurally normal (distinguishes from [[blunt cardiac injury]])
			**CT chest to rule out other traumatic injuries

	==Management==		==Management==
	*~~Standard~~ [[Adult Pulseless Arrest\|~~adult~~]] or [[Pediatric Pulseless Arrest\|~~pediatric~~]] cardiac arrest management		*Immediate [[CPR]] and early defibrillation — standard [[Adult Pulseless Arrest\|ACLS]] or [[Pediatric Pulseless Arrest\|PALS]] cardiac arrest management
	*~~Prognosis~~ is ~~poor,~~ with ~~only 16~~% ~~survival rate<ref name="Ngai" />~~		*'''Early defibrillation is key:''' survival rates improve significantly with prompt AED use
			*Overall survival ~25% (improving with increased bystander CPR and AED availability)

	==Disposition==		==Disposition==
	*Admit to ICU if ROSC is achieved		*Admit to ICU if ROSC achieved
	*~~See~~ [[Post ~~Cardiac Arrest~~]]		*Post-arrest care per [[Post cardiac arrest]] protocol
			*Cardiology consult for monitoring and risk stratification
			*Consider ICD discussion if recurrent arrhythmias post-resuscitation

			==Prevention==
			*Chest protectors (limited efficacy — cannot fully prevent commotio cordis)
			*Safety baseballs (softer core) reduce risk
			*AED availability at all youth sporting events

	==See Also==		==See Also==
	*[[Blunt cardiac injury]]		*[[Blunt cardiac injury]]
	*[[Thoracic trauma]]		*[[Thoracic trauma]]
			*[[Post cardiac arrest]]
			*[[Ventricular fibrillation]]

	==References==		==References==
	<~~References~~/>		<references/>

	[[Category:Cardiology]]		[[Category:Cardiology]]
	[[Category:Trauma]]		[[Category:Trauma]]

Rossdonaldson1: /* Background */

2019-08-17T20:56:05Z

Background

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	**Baseball is most common culprit		**Baseball is most common culprit
	*Autopsy usually shows normal cardiac anatomy with no evidence of damage to heart or other intrathoracic structures<ref name="Ngai">Ngai KY, Chan HY, Ng F. A patient with commotio cordis successfully resuscitated by bystander cardiopulmonary resuscitation and automated external defibrillator. Hong Kong Med J. 2010 Oct;16(5):403-5.</ref>		*Autopsy usually shows normal cardiac anatomy with no evidence of damage to heart or other intrathoracic structures<ref name="Ngai">Ngai KY, Chan HY, Ng F. A patient with commotio cordis successfully resuscitated by bystander cardiopulmonary resuscitation and automated external defibrillator. Hong Kong Med J. 2010 Oct;16(5):403-5.</ref>

			{{Background BCI}}

	===Pathophysiology<ref name="Ngai" />===		===Pathophysiology<ref name="Ngai" />===

Rossdonaldson1: /* See Also */

2019-08-17T20:20:37Z

Rossdonaldson1: /* Clinical Features */

2019-08-17T20:19:38Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
	*Cardiac arrest (usually ventricular fibrillation)		*[[Cardiac arrest]] (usually [[ventricular fibrillation]])

	==Differential Diagnosis==		==Differential Diagnosis==

Alvarez13: /* Pathophysiology */

2017-03-20T00:47:02Z

Pathophysiology

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	===Pathophysiology<ref name="Ngai" />===		===Pathophysiology<ref name="Ngai" />===
	*Primary electrical event resulting in induction of ~~Vfib~~		*Primary electrical event resulting in induction of [[Ventricular Fibrillation]]
	*Likely due to blow occurring 10-30ms before peak of T wave, although this theory is disputed<ref name="Yousef" />		*Likely due to blow occurring 10-30ms before peak of T wave, although this theory is disputed<ref name="Yousef" />
	*Strike directly over cardiac silhouette ↑ risk of developing commotio cordis		*Strike directly over cardiac silhouette ↑ risk of developing commotio cordis

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-22T03:03:12Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 03:03 22 jul 2016
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	{{Thoracic trauma DDX}}		{{Thoracic trauma DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*Clinical		*Clinical

Ostermayer: Text replacement - "Category:Cards" to "Category:Cardiology"

2016-03-22T13:53:49Z

Text replacement - "Category:Cards" to "Category:Cardiology"

← Revisión anterior		Revisión del 13:53 22 mar 2016
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	<References/>		<References/>

	[[Category:~~Cards~~]]		[[Category:Cardiology]]
	[[Category:Trauma]]		[[Category:Trauma]]

Rossdonaldson1: Rossdonaldson1 moved page Commotio Cordis to Commotio cordis

2015-07-24T15:48:51Z

Rossdonaldson1 moved page Commotio Cordis to Commotio cordis

← Revisión anterior	Revisión del 15:48 24 jul 2015
(Sin diferencias)

Mholtz at 10:51, 24 July 2015

2015-07-24T10:51:46Z

← Revisión anterior		Revisión del 10:51 24 jul 2015
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	===Pathophysiology<ref name="Ngai" />===		===Pathophysiology<ref name="Ngai" />===
	*Primary electrical event resulting in induction of Vfib		*Primary electrical event resulting in induction of Vfib
	*Likely due to blow occurring 10-30ms before peak of T wave		*Likely due to blow occurring 10-30ms before peak of T wave, although this theory is disputed<ref name="Yousef" />
	*Strike directly over cardiac silhouette ↑ risk of developing commotio cordis		*Strike directly over cardiac silhouette ↑ risk of developing commotio cordis
	*Younger patients more at risk - compliant chest wall allows transmission of more energy to the heart.		*Younger patients more at risk - compliant chest wall allows transmission of more energy to the heart.

← Revisión anterior		Revisión del 20:20 17 ago 2019
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	==See Also==		==See Also==
	[[Thoracic ~~Trauma~~]]		*[[Blunt cardiac injury]]
			*[[Thoracic trauma]]

	==References==		==References==