Diferencia entre revisiones de «Commotio cordis»

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#REDIRECT[[Myocardial Contusion]]
==Background==
*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)
*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
 
{{Background BCI}}
 
===Pathophysiology===
*Primary electrical event: blow to precordium during the vulnerable period of repolarization (10-30 ms before T-wave peak) triggers [[ventricular fibrillation]]
*Risk factors for commotio cordis:
**Impact directly over the cardiac silhouette
**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==
*Witnessed collapse immediately after chest wall impact
*[[Cardiac arrest]] — usually [[ventricular fibrillation]]
*No external signs of significant chest wall injury
 
==Differential Diagnosis==
{{Thoracic trauma DDX}}
 
==Evaluation==
*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==
*Immediate [[CPR]] and early defibrillation — standard [[Adult Pulseless Arrest|ACLS]] or [[Pediatric Pulseless Arrest|PALS]] cardiac arrest management
*'''Early defibrillation is key:''' survival rates improve significantly with prompt AED use
*Overall survival ~25% (improving with increased bystander CPR and AED availability)
 
==Disposition==
*Admit to ICU if ROSC achieved
*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==
*[[Blunt cardiac injury]]
*[[Thoracic trauma]]
*[[Post cardiac arrest]]
*[[Ventricular fibrillation]]
 
==References==
<references/>
 
[[Category:Cardiology]]
[[Category:Trauma]]

Revisión actual - 10:59 22 mar 2026

Background

  • Sudden cardiac arrest from blunt, non-penetrating chest wall impact in the absence of underlying cardiac disease or structural damage[1]
  • 50% of cases occur during competitive sports (baseball is most common)
  • Most commonly affects young males (median age 14)[2]
  • Autopsy shows structurally normal heart with no myocardial contusion, rib fracture, or other thoracic injury


Blunt cardiac injury

Spectrum of Blunt Cardiac Injury
  • A spectrum of disease due to blunt trauma to the chest wall
  • Ranges from cardiac contusion to infarction to cardiac rupture and death.[3]
    • Commotio cordis is sudden cardiac arrest resulting from blunt chest trauma, in absence of underlying cardiac disease[4]
    • Up to 20% of all MVC deaths are due to blunt cardiac injury

Pathophysiology

  • Primary electrical event: blow to precordium during the vulnerable period of repolarization (10-30 ms before T-wave peak) triggers ventricular fibrillation
  • Risk factors for commotio cordis:
    • Impact directly over the cardiac silhouette
    • 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

Differential Diagnosis

Thoracic Trauma

Evaluation

  • 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

  • Immediate CPR and early defibrillation — standard ACLS or PALS cardiac arrest management
  • Early defibrillation is key: survival rates improve significantly with prompt AED use
  • Overall survival ~25% (improving with increased bystander CPR and AED availability)

Disposition

  • Admit to ICU if ROSC achieved
  • 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

References

  1. ↑ Menezes RG, et al. Commotio cordis: A review. Med Sci Law. 2017 Jul;57(3):146-151. PMID 28587536
  2. ↑ 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
  3. ↑ El-Menyar A, Al Thani H, Zarour A, Latifi R. Understanding traumatic blunt cardiac injury. Ann Card Anaesth. 2012 Oct-Dec;15(4):287-95. doi: 10.4103/0971-9784.101875.
  4. ↑ 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.
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