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Marrone D, Basso C, Thiene G. Commotio cordis: Another cardiac arrest "sine materia". The 1707 early report and interpretation by G.M. Lancisi. Cardiovasc Pathol 2024; 70:107606. [PMID: 38262503 DOI: 10.1016/j.carpath.2024.107606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/25/2024] Open
Abstract
Sudden death by commotio cordis is rare. It is the consequence of a blunt trauma of the chest overlying the heart. The mechanism is a cardiac arrest by ventricular fibrillation in the absence of grossly or microscopically apparent myocardial injury. It has been reproduced in animals. The first historical case was reported by Giovanni Maria Lancisi in his book "De Subitaneis Mortibus'' published in 1707. Sudden death occurred in a man receiving a powerful blow under the xiphoid cartilage. Lancisi advanced the hypothesis of acute heart failure by a diastolic stand still ("death in diastole'').
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Affiliation(s)
- Daniela Marrone
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy.
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2
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Gozun M, Vu K, Nishimura Y, Ghukasyan H, Zhang J, Kemble-Luo A, Singh D. Cliff diving leading to commotio cordis in a patient with Ebstein's anomaly. J Cardiol Cases 2023; 28:250-252. [PMID: 38126049 PMCID: PMC10730268 DOI: 10.1016/j.jccase.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 12/23/2023] Open
Abstract
In this case report, we describe a 23-year-old male with Ebstein's anomaly who experienced out-of-hospital cardiac arrest due to commotio cordis following cliff diving. The patient previously underwent a Cone procedure and re-do reduction tricuspid valvuloplasty. Comprehensive investigations revealed no new ischemic events or structural abnormalities. He received an implantable cardioverter-defibrillator during an uneventful outpatient visit. This is the first reported case of commotio cordis in a patient with Ebstein's anomaly, suggesting a potential increased risk in individuals with congenital heart diseases. This highlights the significance of tertiary prevention in such cases. Learning objective Through this case, readers may be able to review the incidence and electrical abnormalities leading to sudden cardiac death in patients with commotio cordis, the clinical presentation and mechanism of injury, and the current consensus regarding the management of commotio cordis.
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Affiliation(s)
- Maan Gozun
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Kimberly Vu
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Hayk Ghukasyan
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - James Zhang
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Anne Kemble-Luo
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
- Queen's Heart Institute, The Queen's Medical Center, Honolulu, HI, USA
| | - David Singh
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
- Queen's Heart Institute, The Queen's Medical Center, Honolulu, HI, USA
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3
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Melo L, Patail H, Sharma T, Frishman WH, Aronow WS. Commotio Cordis: A Comprehensive Review. Cardiol Rev 2023:00045415-990000000-00150. [PMID: 37729588 DOI: 10.1097/crd.0000000000000611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Commotio cordis is a rare, however, potentially fatal, cardiovascular phenomenon arising from direct chest wall trauma, causing sudden cardiac arrest and potentially death. It is primarily seen in young athletes who participate in contact and organized sports. Though debated, the cause of commotio cordis is believed to involve specific timing of chest impact during ventricular electrical activity leading to severe arrhythmic events. Due to sudden onset, the first step in management is immediate and effective basic life support with automated external defibrillation, followed by advanced cardiac life support. Future considerations should include secondary prevention measures such as protective padding in contact sports. It is paramount that clinicians are vigilant in recognizing potential cases of commotio cordis in the field and provide immediate care. This review consolidates the current understanding of commotio cordis, emphasizing the importance of awareness and early intervention. Future research is warranted, including retrospective and observational studies to identify high-risk patterns or trends associated with the condition.
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Affiliation(s)
- Lara Melo
- From the Department of Internal Medicine, University of Connecticut School of Medicine, NY
| | - Haris Patail
- From the Department of Internal Medicine, University of Connecticut School of Medicine, NY
| | - Tanya Sharma
- Department of Cardiology, Westchester Medical Center New York Medical College, NY
| | - William H Frishman
- Department of Medicine, Westchester Medical Center New York Medical College,NY
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center New York Medical College, NY
- Department of Medicine, Westchester Medical Center New York Medical College,NY
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Abstract
Since the nationally televised cardiac arrest of American National Football League player Damar Hamlin in January 2023, commotio cordis has come to the forefront of public attention. Commotio cordis is defined as sudden cardiac arrest due to direct trauma to the precordium resulting in ventricular fibrillation or ventricular tachycardia. While the precise incidence of commotio cordis is not known due to a lack of standardized, mandated reporting, it is the third most common cause of sudden cardiac death in young athletes, with more than 75% of cases occurring during organized and recreational sporting events. Given that survival is closely tied to how quickly victims receive cardiopulmonary resuscitation and defibrillation, it is crucial to raise awareness of commotio cordis so that athletic trainers, coaches, team physicians, and emergency medical personnel can rapidly diagnose and treat this often-fatal condition. Broader distribution of automated external defibrillators in sporting facilities as well as increased presence of medical personnel during sporting events would also likely lead to higher survival rates.
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Affiliation(s)
- Theodore Peng
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Laura Trollinger Derry
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Vidhushei Yogeswaran
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Nora F Goldschlager
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division of Cardiology, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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5
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Lee RN, Sampaio Rodrigues T, Gan JT, Han HC, Mikhail R, Sanders P, Farouque O, Lim HS. Commotio Cordis in Non-Sport-Related Events: A Systematic Review. JACC Clin Electrophysiol 2023; 9:1321-1329. [PMID: 37558288 DOI: 10.1016/j.jacep.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/28/2022] [Accepted: 01/09/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Commotio cordis is an increasingly recognized cause of sudden cardiac death. Although commonly linked with athletes, many events occur in non-sport-related settings. OBJECTIVES The goal of this study was to characterize and compare non-sport-related vs sport-related commotio cordis. METHODS PubMed and Embase were searched for all cases of commotio cordis from inception to January 5, 2022. RESULTS Of 334 commotio cordis cases identified, 121 (36%) occurred in non-sport-related contexts, which included assault (76%), motor vehicle accidents (7%), and daily activities (16%). Projectiles were implicated significantly less in non-sport-related events (5% vs 94%, respectively; P < 0.001). Nonprojectile etiologies in non-sport-related events mostly consisted of impacts with body parts (79%). Both categories affected similar younger aged demographic (P = 0.10). The proportion of female victims was significantly higher in non-sport-related events (13% vs 2%, respectively; P = 0.025). Mortality was significantly higher in non-sport-related events (88% vs 66%, respectively; P < 0.001). In non-sport-related events, rates of cardiopulmonary resuscitation (27% vs 97%, respectively; P < 0.001) and defibrillation (17% vs 81%, respectively; P < 0.001) were both lower and resuscitation was more commonly delayed beyond 3 min (80% vs 5%, respectively; P < 0.001). CONCLUSIONS Commotio cordis occurs across a spectrum of non-sport-related settings including assault, motor vehicle accidents, and daily activities. Both categories affected a younger and male-predominant demographic. Mortality is higher in non-sport-related commotio cordis, likely owing to lower rates of cardiopulmonary resuscitation, defibrillation, automated external defibrillator availability, and extended time to resuscitation. Increased awareness of non-sport-related commotio cordis is essential to develop a means of prevention and mortality reduction, with earlier recognition and prompt resuscitation measures.
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Affiliation(s)
- Rafael N Lee
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia
| | - Thalys Sampaio Rodrigues
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia. https://twitter.com/drThalysSR
| | - Joscelyn T Gan
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia
| | - Hui-Chen Han
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia
| | - Rama Mikhail
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia
| | - Prashanthan Sanders
- South Australia Health and Medical Research Institute, Adelaide, South Australia, Australia; Royal Adelaide Hospital, Adelaide, South Australia, Australia. https://twitter.com/PrashSanders
| | - Omar Farouque
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia
| | - Han S Lim
- University of Melbourne Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia; Austin Health, Melbourne, Victoria, Australia.
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Okorare O, Alugba G, Olusiji S, Evbayekha EO, Antia AU, Daniel E, Ubokudum D, Adabale OK, Ariaga A. Sudden Cardiac Death: An Update on Commotio Cordis. Cureus 2023; 15:e38087. [PMID: 37252546 PMCID: PMC10209547 DOI: 10.7759/cureus.38087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Sudden cardiac death (SCD) is one of the leading causes of cardiovascular mortality, and it is caused by a diverse array of conditions. Among these is commotio cordis, a relatively infrequent but still significant cause, often seen in young athletes involved in competitive or recreational sports. It is known to be caused by blunt trauma to the chest wall resulting in life-threatening arrhythmia (typically ventricular fibrillation). The current understanding pertains to blunt trauma to the precordium, with an outcome depending on factors such as the type of stimulus, the force of impact, the qualities of the projectile (shape, size, and density), the site of impact, and the timing of impact in relation to the cardiac cycle. In the management of commotio cordis, a history of preceding blunt chest trauma is usually encountered. Imaging is mostly unremarkable except for ECG, which may show malignant ventricular arrhythmias. Treatment is focused on emergent resuscitation with the advanced cardiac life support protocol algorithm, with extensive workup following the return of spontaneous circulation. In the absence of underlying cardiovascular pathologies, implantable cardiac defibrillator insertion is not beneficial, and patients can even resume physical activity if the workup is unremarkable. Proper follow-up is also key in the management and monitoring of re-entrant ventricular arrhythmias, which are amenable to ablative therapy. Prevention of this condition involves protecting the chest wall against blunt trauma, especially with the use of safety balls and chest protectors in certain high-risk sporting activities. This study aims to elucidate the current epidemiology and clinical management of SCD with a particular focus on a rarely explored etiology, commotio cordis.
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Affiliation(s)
- Ovie Okorare
- Internal Medicine, Nuvance Health Vassar Brothers Medical Center, New York, USA
| | | | - Soremi Olusiji
- Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | | | - Akanimo U Antia
- Medicine, Lincoln Medical and Mental Health Center, New York, USA
| | | | | | | | - Anderson Ariaga
- Internal Medicine, Nuvance Health Vassar Brothers Medical Center, New York, USA
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7
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Frishman WH, Alpert JS. Commotio Cordis and the Triumph of Out-of-Hospital Cardiopulmonary Resuscitation. Am J Med 2023; 136:401-402. [PMID: 36736646 DOI: 10.1016/j.amjmed.2023.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/24/2023] [Indexed: 02/01/2023]
Affiliation(s)
- William H Frishman
- New York Medical College/Westchester Medical Center, Valhalla; Supplements Editor, The American Journal of Medicine
| | - Joseph S Alpert
- Department of Medicine, University of Arizona, Tucson; Editor in Chief, The American Journal of Medicine.
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8
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A Recreational Fishing Death Due to a Jumping Spanish Mackerel (Scomberomorus commerson). Am J Forensic Med Pathol 2021; 42:397-400. [PMID: 33491955 PMCID: PMC8608006 DOI: 10.1097/paf.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Commercial or recreational fishing may be associated with a wide range of potentially lethal events. We report the case of a 56-year-old man who died of blunt force chest and abdominal trauma after impact with a large Spanish mackerel (Scomberomorus commerson) that had jumped into his recreational fishing boat. Injuries at autopsy included soft tissue bruising with fractured ribs, a ruptured diaphragm, intestinal and mesenteric contusions, contusion and disruption of the pancreas, and hilar splenic lacerations with a left-sided hemothorax and a hematoperitoneum. The clear temporal association of pain and progressive deterioration leading to cardiac arrest after the impact indicated that lethal injuries had been sustained. A variety of fish and cetacean species are known to jump out of the water sometimes to escape predators. It was reported that a large number of jumping fish being pursued by sharks were observed in the harbor on the day of the reported incident. This case demonstrates that lethal blunt abdominothoracic trauma may be caused by impact with Spanish mackerel, increasing the range of potentially dangerous situations that may be encountered while fishing.
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El Masri I, Kayali SM, Blount C, Kirolos I, Khouzam JP, Kabra R. Is Exercise Helpful or Harmful in Dealing With Specific Arrhythmia. Curr Probl Cardiol 2020; 46:100740. [PMID: 33213943 DOI: 10.1016/j.cpcardiol.2020.100740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022]
Abstract
Exercise is universally known to benefit health by lowering risk for cardiovascular disease and mortality. However, in patients with pre-existing cardiac conditions, including channelopathies, cardiomyopathies and coronary artery disease, exercise can cause sudden cardiac death (SCD). In this review, we explore exercise related risks and current recommendations for specific conditions. The risk of myocardial infarction (MI) during strenuous exercise in asymptomatic individuals with coronary artery disease is decreased with habitual exercise, especially if they have a normal ejection fraction and no ischemia. Furthermore, cardiac rehabilitation has been shown to be beneficial in heart failure. On the other hand, surgery is recommended for certain anomalous coronaries prior to engaging in vigorous activity. In addition, both exercise-induced disease progression and SCD in arrhythmogenic cardiomyopathy restrict ability to engage in competitive sports, as is the case in hypertrophic cardiomyopathy. Other diseases, like myocarditis only cause temporary risk for SCD. Previously considered benign, common conditions like early repolarization do increase SCD risk. Finally, certain gear including thicker chest protectors for athletes engaging in sports with hard, small spherical objects decrease risk of commotio cordis. While significant advances have been achieved in diagnosing and treating previously unrecognized conditions that predispose to sudden cardiac death, more research is needed to further tailor recommendations to allow beneficial exercise in those with rarer conditions that are under-represented in large systemic studies.
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10
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Quinn TA, Kohl P. Cardiac Mechano-Electric Coupling: Acute Effects of Mechanical Stimulation on Heart Rate and Rhythm. Physiol Rev 2020; 101:37-92. [PMID: 32380895 DOI: 10.1152/physrev.00036.2019] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The heart is vital for biological function in almost all chordates, including humans. It beats continually throughout our life, supplying the body with oxygen and nutrients while removing waste products. If it stops, so does life. The heartbeat involves precise coordination of the activity of billions of individual cells, as well as their swift and well-coordinated adaption to changes in physiological demand. Much of the vital control of cardiac function occurs at the level of individual cardiac muscle cells, including acute beat-by-beat feedback from the local mechanical environment to electrical activity (as opposed to longer term changes in gene expression and functional or structural remodeling). This process is known as mechano-electric coupling (MEC). In the current review, we present evidence for, and implications of, MEC in health and disease in human; summarize our understanding of MEC effects gained from whole animal, organ, tissue, and cell studies; identify potential molecular mediators of MEC responses; and demonstrate the power of computational modeling in developing a more comprehensive understanding of ‟what makes the heart tick.ˮ.
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Affiliation(s)
- T Alexander Quinn
- Department of Physiology and Biophysics and School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical Faculty of the University of Freiburg, Freiburg, Germany; and CIBSS-Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | - Peter Kohl
- Department of Physiology and Biophysics and School of Biomedical Engineering, Dalhousie University, Halifax, Nova Scotia, Canada; Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical Faculty of the University of Freiburg, Freiburg, Germany; and CIBSS-Centre for Integrative Biological Signalling Studies, University of Freiburg, Freiburg, Germany
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11
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Lupariello F, Di Vella G. A Stricter Approach for Commotio Cordis in Lethal Cases. Am J Cardiol 2019; 124:1649. [PMID: 31500817 DOI: 10.1016/j.amjcard.2019.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 08/13/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Francesco Lupariello
- Department of Public Health and Pediatric Sciences, Legal Medicine Unit, University of Turin, Turin; Italy
| | - Giancarlo Di Vella
- Department of Public Health and Pediatric Sciences, Legal Medicine Unit, University of Turin, Turin; Italy
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12
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The role of the autopsy in the diagnosis of commotio cordis lethal cases: Review of the literature. Leg Med (Tokyo) 2019; 38:73-76. [DOI: 10.1016/j.legalmed.2019.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/31/2019] [Accepted: 04/23/2019] [Indexed: 11/20/2022]
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13
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Lupariello F, Curti SM, Di Vella G. Diagnostic Criteria for Commotio Cordis Caused by Violent Attack: Review of the Literature. Am J Forensic Med Pathol 2018; 39:330-336. [PMID: 30234548 DOI: 10.1097/paf.0000000000000433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The diagnosis of lethal commotio cordis (CC) is really complex. The forensic pathologist's task is even more relevant when he/she has to explain a CC diagnosis caused by an assault in a trial. The purpose of this study was to analyze the literature on lethal CC as a result of violent attacks and identify relevant parameters that may help in the diagnosis. A review of the relevant articles was performed. Fifty-two cases of CC caused by violent attacks were identified. The collected data allowed to confirm the following literature's criteria for CC diagnosis in case of assaults: witnessed occurrence of a blunt, nonpenetrating blow to the chest preceding cardiovascular collapse; absence of structural damage to the sternum, ribs, or heart itself; and absence of any underlying cardiovascular abnormalities (such as other causes of sudden death). Regarding the assessment of the third criterion, the authors suggest that the pathologist should always specify the scientific autopsy guidelines that he/she used to differentiate CC from the other causes of sudden death. In addition, the authors highlight the importance of a multidisciplinary approach for a correct interpretation of clinical, autopsy, and laboratory findings.
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Affiliation(s)
- Francesco Lupariello
- From the Sezione di Medicina Legale, Dipartimento di Scienze della Sanità Pubblica e Pediatriche, "Università degli Studi di Torino," Torino, Italy
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14
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Arens S, Dierckx H, Panfilov AV. GEMS: A Fully Integrated PETSc-Based Solver for Coupled Cardiac Electromechanics and Bidomain Simulations. Front Physiol 2018; 9:1431. [PMID: 30386252 PMCID: PMC6198176 DOI: 10.3389/fphys.2018.01431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 09/20/2018] [Indexed: 01/23/2023] Open
Abstract
Cardiac contraction is coordinated by a wave of electrical excitation which propagates through the heart. Combined modeling of electrical and mechanical function of the heart provides the most comprehensive description of cardiac function and is one of the latest trends in cardiac research. The effective numerical modeling of cardiac electromechanics remains a challenge, due to the stiffness of the electrical equations and the global coupling in the mechanical problem. Here we present a short review of the inherent assumptions made when deriving the electromechanical equations, including a general representation for deformation-dependent conduction tensors obeying orthotropic symmetry, and then present an implicit-explicit time-stepping approach that is tailored to solving the cardiac mono- or bidomain equations coupled to electromechanics of the cardiac wall. Our approach allows to find numerical solutions of the electromechanics equations using stable and higher order time integration. Our methods are implemented in a monolithic finite element code GEMS (Ghent Electromechanics Solver) using the PETSc library that is inherently parallelized for use on high-performance computing infrastructure. We tested GEMS on standard benchmark computations and discuss further development of our software.
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Affiliation(s)
- Sander Arens
- Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - Hans Dierckx
- Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - Alexander V Panfilov
- Department of Physics and Astronomy, Ghent University, Ghent, Belgium.,Laboratory of Computational Biology and Medicine, Ural Federal University, Ekaterinburg, Russia
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15
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Madias C, Maron BJ, Dau N, Estes NAM, Bir C, Link MS. Size as an Important Determinant of Chest Blow-induced Commotio Cordis. Med Sci Sports Exerc 2018; 50:1767-1771. [PMID: 29620687 DOI: 10.1249/mss.0000000000001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Commotio cordis is sudden cardiac death caused by a relatively innocent blow to the left chest wall. Adolescents account for the majority of the cases; whether this is due to the higher frequency of adolescents playing ball sports or whether there is some maturational reduction of risk is not known. METHODS In a swine model of commotio cordis, the effect of body weight/size (directly related to age) to the susceptibility of chest impact-induced ventricular fibrillation (VF) is examined. METHODS Ball impacts were delivered at escalating velocities from 48.3 to 96.9 km·h (30-60 mph) to 128 swine ranging in weight from 5 to 54 kg. RESULTS VF occurred in 29% of impacts to the smallest animals compared with 34% in the 14- to 239-kg group, 27% in the 24- to 33.9-kg group, 30% in 34- to 43-kg group, and 15% in the 44- to 54-kg animals. The highest-weight group was associated with a significantly lower incidence of VF compared with other weights (P = 0.002). In a multivariate logistic regression analysis, controlling for repeated measures, four variables predicted VF: body weight (P = 0.0008), velocity (P < 0.0001), distance from the center of the heart, (P < 0.0001), and peak left ventricular pressure induced by the blow (P = 0.0007). CONCLUSIONS In this experimental model, animals weighing <44 kg seem to have a similar susceptibility to commotio cordis, whereas animals weighing ≥44 kg have a lower susceptibility. An increase in size of the individual, rather than reduced play of ball sports, is the likely reason for the decreased commotio cordis incidence in older individuals.
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Affiliation(s)
| | - Barry J Maron
- Tufts Medical Center, Cardiac Arrhythmia Center, Boston, MA
| | - Nathan Dau
- Biomedical Engineering Center, Wayne State University, Detroit, MI
| | | | - Cynthia Bir
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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16
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Quinn TA, Jin H, Lee P, Kohl P. Mechanically Induced Ectopy via Stretch-Activated Cation-Nonselective Channels Is Caused by Local Tissue Deformation and Results in Ventricular Fibrillation if Triggered on the Repolarization Wave Edge (Commotio Cordis). Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004777. [PMID: 28794084 PMCID: PMC5555388 DOI: 10.1161/circep.116.004777] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 07/07/2017] [Indexed: 12/11/2022]
Abstract
Supplemental Digital Content is available in the text. Background— External chest impacts (commotio cordis) can cause mechanically induced premature ventricular excitation (PVEM) and, rarely, ventricular fibrillation (VF). Because block of stretch-sensitive ATP-inactivated potassium channels curtailed VF occurrence in a porcine model of commotio cordis, VF has been suggested to arise from abnormal repolarization caused by stretch activation of potassium channels. Alternatively, VF could result from abnormal excitation by PVEM, overlapping with normal repolarization-related electric heterogeneity. Here, we investigate mechanisms and determinants of PVEM induction and its potential role in commotio cordis–induced VF. Methods and Results— Subcontusional mechanical stimuli were applied to isolated rabbit hearts during optical voltage mapping, combined with pharmacological block of ATP-inactivated potassium or stretch-activated cation-nonselective channels. We demonstrate that local mechanical stimulation reliably triggers PVEM at the contact site, with inducibility predicted by local tissue indentation. PVEM induction is diminished by pharmacological block of stretch-activated cation-nonselective channels. In hearts where electrocardiogram T waves involve a well-defined repolarization edge traversing the epicardium, PVEM can reliably provoke VF if, and only if, the mechanical stimulation site overlaps the repolarization wave edge. In contrast, application of short-lived intraventricular pressure surges neither triggers PVEM nor changes repolarization. ATP-inactivated potassium channel block has no effect on PVEM inducibility per se, but shifts it to later time points by delaying repolarization and prolonging refractoriness. Conclusions— Local mechanical tissue deformation determines PVEM induction via stretch-activation of cation-nonselective channels, with VF induction requiring PVEM overlap with the trailing edge of a normal repolarization wave. This defines a narrow, subject-specific vulnerable window for commotio cordis–induced VF that exists both in time and in space.
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Affiliation(s)
- T Alexander Quinn
- From the Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada (T.A.Q.); Department of Physiology, Anatomy, and Genetics, University of Oxford, United Kingdom (H.J., P.L.); and Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical School of the University of Freiburg, Germany (P.K.).
| | - Honghua Jin
- From the Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada (T.A.Q.); Department of Physiology, Anatomy, and Genetics, University of Oxford, United Kingdom (H.J., P.L.); and Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical School of the University of Freiburg, Germany (P.K.)
| | - Peter Lee
- From the Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada (T.A.Q.); Department of Physiology, Anatomy, and Genetics, University of Oxford, United Kingdom (H.J., P.L.); and Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical School of the University of Freiburg, Germany (P.K.)
| | - Peter Kohl
- From the Department of Physiology and Biophysics, Dalhousie University, Halifax, Nova Scotia, Canada (T.A.Q.); Department of Physiology, Anatomy, and Genetics, University of Oxford, United Kingdom (H.J., P.L.); and Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Medical School of the University of Freiburg, Germany (P.K.)
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Collet A, Bragard J, Dauby PC. Temperature, geometry, and bifurcations in the numerical modeling of the cardiac mechano-electric feedback. CHAOS (WOODBURY, N.Y.) 2017; 27:093924. [PMID: 28964162 DOI: 10.1063/1.5000710] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article characterizes the cardiac autonomous electrical activity induced by the mechanical deformations in the cardiac tissue through the mechano-electric feedback. A simplified and qualitative model is used to describe the system and we also account for temperature effects. The analysis emphasizes a very rich dynamics for the system, with periodic solutions, alternans, chaotic behaviors, etc. The possibility of self-sustained oscillations is analyzed in detail, particularly in terms of the values of important parameters such as the dimension of the system and the importance of the stretch-activated currents. It is also shown that high temperatures notably increase the parameter ranges for which self-sustained oscillations are observed and that several attractors can appear, depending on the location of the initial excitation of the system. Finally, the instability mechanisms by which the periodic solutions are destabilized have been studied by a Floquet analysis, which has revealed period-doubling phenomena and transient intermittencies.
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Affiliation(s)
- A Collet
- GIGA In silico medicine, Liège University, B-4000 Liège, Belgium
| | - J Bragard
- Physics and Applied Math. Dept., Universidad de Navarra, Pamplona E-31080, Spain
| | - P C Dauby
- GIGA In silico medicine, Liège University, B-4000 Liège, Belgium
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Menezes RG, Fatima H, Hussain SA, Ahmed S, Singh PK, Kharoshah MA, Madadin M, Ram P, Pant S, Luis SA. Commotio cordis: A review. MEDICINE, SCIENCE, AND THE LAW 2017; 57:146-151. [PMID: 28587536 DOI: 10.1177/0025802417712883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Commotio cordis is an increasingly reported fatal mechano-electric syndrome and is the second most common cause of sudden cardiac death in young athletes. It is most commonly associated with a sports-related injury, wherein, there is a high-velocity impact between a projectile and the precordium. By virtue of this impact, malignant arrhythmias consequently develop leading to the individual's immediate demise, accompanied by a relatively normal post-mortem analysis. The importance of an autopsy remains paramount to exclude other causes of sudden death. With increasing awareness and reporting, survival rates are beginning to improve; however, prevention of the development of this condition remains the best approach for survival.
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Affiliation(s)
- Ritesh G Menezes
- 1 Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia (KSA)
| | - Huda Fatima
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Ather Hussain
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Saba Ahmed
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Pankaj Kumar Singh
- 3 Department of Forensic Medicine, Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | - Mohammed Madadin
- 1 Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, University of Dammam, Dammam, Saudi Arabia (KSA)
| | - Pradhum Ram
- 5 Albert Einstein Medical Centre, Philadelphia, PA, USA
| | - Sadip Pant
- 6 Division of Cardiovascular Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Sushil Allen Luis
- 7 School of Medicine, The University of Queensland, Brisbane, Australia
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Decher N, Kiper AK, Rinné S. Stretch-activated potassium currents in the heart: Focus on TREK-1 and arrhythmias. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2017; 130:223-232. [PMID: 28526352 DOI: 10.1016/j.pbiomolbio.2017.05.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/09/2017] [Accepted: 05/15/2017] [Indexed: 12/26/2022]
Abstract
This review focuses on the role and the molecular candidates of the cardiac stretch-activated potassium current (SAK). The functional properties of the two-pore domain potassium (K2P) channel TREK-1, a major candidate for the cardiac SAK, are analyzed and the molecular mechanism of stretch-activation in K2P potassium channels is discussed. Furthermore, the functional modulation of TREK-1 by different cardiac interaction partners, as well as evidence for the functional role of the stretch-dependent TREK-1 and its putative subunits in the heart is reviewed. In addition, we summarize the recent evidence that TREK-1 is involved in the pathogenesis of human cardiac arrhythmias.
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Affiliation(s)
- Niels Decher
- Institute for Physiology and Pathophysiology, AG Vegetative Physiology, Deutschhausstrasse 1-2, 35037 Marburg, Germany.
| | - Aytug K Kiper
- Institute for Physiology and Pathophysiology, AG Vegetative Physiology, Deutschhausstrasse 1-2, 35037 Marburg, Germany
| | - Susanne Rinné
- Institute for Physiology and Pathophysiology, AG Vegetative Physiology, Deutschhausstrasse 1-2, 35037 Marburg, Germany
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20
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Jin H, Iribe G, Naruse K. Effects of bepridil on stretch-activated BKca channels and stretch-induced extrasystoles in isolated chick hearts. Physiol Res 2017; 66:459-465. [PMID: 28248537 DOI: 10.33549/physiolres.933315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Various types of mechanosensitive ion channels, including cationic stretch-activated channels (SAC(NS)) and stretch-activated BKca (SAKca) channels, modulate heart rhythm. Bepridil has been used as an antiarrhythmic drug with multiple pharmacological effects; however, whether it is effective for mechanically induced arrhythmia has not been well investigated. To test the effects of Bepridil on SAKca channels activity, cultured chick embryonic ventricular myocytes were used for single-channel recordings. Bepridil significantly reduced the open probability of the SAKca channel (P(O)). Next, to test the effects of bepridil on stretch-induced extrasystoles (SIE), we used an isolated 2-week-old Langendorff-perfused chick heart. The left ventricle (LV) volume was rapidly changed, and the probability of SIE was calculated in the presence and absence of bepridil, and the effect of the drug was compared with that of Gadolinium (Gd(3+)). Bepridil decreased the probability of SIE despite its suppressive effects on SAKca channel activity. The effects of Gd(3+), which blocks both SAKca and SAC(NS), on the probability of SIE were the same as those of bepridil. Our results suggest that bepridil blocks not only SAKca channels but possible also blocks SAC(NS), and thus decreases the stretch-induced cation influx (stabilizing membrane potential) to compensate and override the effects of the decrease in outward SAKca current (destabilizing membrane potential).
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Affiliation(s)
- H Jin
- Department of Pharmacy, The Affiliated Hospital of YanBian University, YanJi City, JiLin Province, China. ; Cardiovascular Physiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan.
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Abstract
Mechanical forces will have been omnipresent since the origin of life, and living organisms have evolved mechanisms to sense, interpret, and respond to mechanical stimuli. The cardiovascular system in general, and the heart in particular, is exposed to constantly changing mechanical signals, including stretch, compression, bending, and shear. The heart adjusts its performance to the mechanical environment, modifying electrical, mechanical, metabolic, and structural properties over a range of time scales. Many of the underlying regulatory processes are encoded intracardially and are, thus, maintained even in heart transplant recipients. Although mechanosensitivity of heart rhythm has been described in the medical literature for over a century, its molecular mechanisms are incompletely understood. Thanks to modern biophysical and molecular technologies, the roles of mechanical forces in cardiac biology are being explored in more detail, and detailed mechanisms of mechanotransduction have started to emerge. Mechano-gated ion channels are cardiac mechanoreceptors. They give rise to mechano-electric feedback, thought to contribute to normal function, disease development, and, potentially, therapeutic interventions. In this review, we focus on acute mechanical effects on cardiac electrophysiology, explore molecular candidates underlying observed responses, and discuss their pharmaceutical regulation. From this, we identify open research questions and highlight emerging technologies that may help in addressing them.
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Affiliation(s)
- Rémi Peyronnet
- From the National Heart and Lung Institute, Imperial College London, United Kingdom (R.P., P.K.); Departments of Developmental Biology and Internal Medicine, Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, MO (J.M.N.); Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Freiburg, Germany (R.P., P.K.)
| | - Jeanne M Nerbonne
- From the National Heart and Lung Institute, Imperial College London, United Kingdom (R.P., P.K.); Departments of Developmental Biology and Internal Medicine, Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, MO (J.M.N.); Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Freiburg, Germany (R.P., P.K.)
| | - Peter Kohl
- From the National Heart and Lung Institute, Imperial College London, United Kingdom (R.P., P.K.); Departments of Developmental Biology and Internal Medicine, Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, MO (J.M.N.); Institute for Experimental Cardiovascular Medicine, University Heart Centre Freiburg/Bad Krozingen, Freiburg, Germany (R.P., P.K.).
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22
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Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma. Cardiol Res Pract 2016; 2016:7270247. [PMID: 26981308 PMCID: PMC4766339 DOI: 10.1155/2016/7270247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/13/2016] [Indexed: 11/21/2022] Open
Abstract
Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis) and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.
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Abstract
This article describes the case of a 17-year-old adolescent boy who received a foot kick in the trunk area from an expert in karate. He presented with immediate cardiocirculatory arrest. After a prolonged resuscitation, he was transferred to a hospital where he died 5 days later without ever regaining consciousness. Postmortem investigations including autopsy, radiology, histology, toxicology, and postmortem chemistry were performed that showed signs of multiple organ failure, an acute hemorrhage in the region of the celiac plexus, and signs of medical resuscitation. No preexisting disease, particularly those concerning the heart, was objectified. The cause of death was attributed to multiple organ failure after a prolonged cardiocirculatory arrest. Concerning the origin of the cardiac arrest, 2 hypotheses were considered-a cardioinhibitory reflex and a cardiac contusion (commotio cordis). Because of the presence of traumatic lesions in the celiac plexus, the first hypothesis was finally submitted. This case is reported because rare cases of sudden death from celiac reflex are described in the literature where it is almost impossible to find references with accurate documentation. The presented case confirms the importance of detailed documentation of the circumstances and postmortem investigations to establish a diagnosis of death due to cardioinhibitory reflex.
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Mu J, Chen Z, Chen X, Lin W, Dong H. Commotio Cordis Caused by Violence in China: Epidemiological Characteristics Detected at the Tongji Forensic Medical Center. Medicine (Baltimore) 2015; 94:e2315. [PMID: 26705218 PMCID: PMC4697984 DOI: 10.1097/md.0000000000002315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Commotio cordis (CC) is a recognized rare cause of sudden death in which an apparently minor blow to the chest causes ventricular fibrillation and cardiac arrest. CC diagnosis is still a challenge for forensic pathologists. A retrospective study of 9794 autopsy cases was conducted at the Department of Forensic Medicine, Tongji Medical College (DFM-TMC, China) from 1955 to 2014. A total of 39 cases (0.4%) were determined to be caused by CC. A male preponderance (male to female of 37:2) was found in the victims, whose age ranged from 13 to 47 years, including more than 85% individuals in their 10s and 20s. Most victims (27 cases, 69.2%) came from village. The highest rate of victims was found for middle school and college students (15 cases, 38.5%), followed by prisoners (11 cases, 28.2%), farmers (9 cases, 23.1%), workers (3 cases, 7.7%), and office staff (1 case, 2.6%). Chest blows were produced by fists (28 cases, 71.8%), feet (6 cases, 15.4%), knee (2 case, 5.1%), head (1 case, 2.6%), or objects (2 cases, 5.1%). Witness statements indicated that most victims collapsed after being impacted in the precordium. The autopsy findings were unremarkable except bruises, contusions, or subcutaneous hemorrhage in the anterior chest (13 cases), bleeding of intercostal muscles (5 cases), and disperse focal petechiae of the epicardium (11 cases). All CC cases in this study were caused by violent attacks and related to criminal processes. Correct diagnosis of CC due to violence has important implications in the judicial system.
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Affiliation(s)
- Jiao Mu
- From the Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan (JM, ZC, XC, WL, HD), and Department of Pathology, Hebei North University, Zhangjiakou, Hebei, P.R. China (JM)
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25
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Opthof T, Meijborg VMF, Belterman CNW, Coronel R. Synchronization of repolarization by mechano-electrical coupling in the porcine heart. Cardiovasc Res 2015; 108:181-7. [PMID: 25935868 DOI: 10.1093/cvr/cvv140] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 04/15/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS The aim of this study was to evaluate the effect of increase in left ventricular (LV) pressure on repolarization and activation-recovery intervals. METHODS AND RESULTS Six pig hearts were Langendorff-perfused. A compliant liquid-filled balloon, connected with a pressure transducer, inserted through the mitral orifice, could be filled until the required LV systolic pressure was obtained. A grid of 121 electrodes (11 × 11; 5 mm interelectrode distance) was sutured on the LV free wall. Ventricular pacing at 600 ms and at 400 or 450 ms was either performed from the LV wall or from the ventricular septum. Under all these four conditions, the pressure wave occurred at the same moment relative to the onset of the QRS complex. Consequently, the time relation between local repolarization and the pressure wave differed between the various pacing sites. Repolarization times (RTs) at a cycle length (CL) of 600 ms were prolonged by increased pressure. With stimulation from the LV, when the pressure wave coincides with the action potentials (APs) late in their phase (sites with relatively early repolarization), an increase in pressure from 0 to 100 mmHg delayed repolarization more than with stimulation from the septum, when the pressure wave occurs at a relatively earlier phase of the AP (sites with relatively late repolarization). At pacing at CL 400/450 ms, an increase in pressure caused RT prolongation at the LV free wall during LV stimulation, but less RT prolongation or even shortening during septal stimulation. CONCLUSION The effect of increased LV pressure is synchronization of repolarization.
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Affiliation(s)
- Tobias Opthof
- Experimental Cardiology Group, Department of Clinical and Experimental Cardiology, Academic Medical Centre, Room K2-112, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Veronique M F Meijborg
- Experimental Cardiology Group, Department of Clinical and Experimental Cardiology, Academic Medical Centre, Room K2-112, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Charly N W Belterman
- Experimental Cardiology Group, Department of Clinical and Experimental Cardiology, Academic Medical Centre, Room K2-112, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands University Bordeaux Segalen, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Bordeaux, France
| | - Ruben Coronel
- Experimental Cardiology Group, Department of Clinical and Experimental Cardiology, Academic Medical Centre, Room K2-112, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands University Bordeaux Segalen, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Bordeaux, France
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Reed A, Kohl P, Peyronnet R. Molecular candidates for cardiac stretch-activated ion channels. Glob Cardiol Sci Pract 2014; 2014:9-25. [PMID: 25405172 PMCID: PMC4220428 DOI: 10.5339/gcsp.2014.19] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Accepted: 06/08/2014] [Indexed: 01/20/2023] Open
Abstract
The heart is a mechanically-active organ that dynamically senses its own mechanical environment. This environment is constantly changing, on a beat-by-beat basis, with additional modulation by respiratory activity and changes in posture or physical activity, and further overlaid with more slowly occurring physiological (e.g. pregnancy, endurance training) or pathological challenges (e.g. pressure or volume overload). Far from being a simple pump, the heart detects changes in mechanical demand and adjusts its performance accordingly, both via heart rate and stroke volume alteration. Many of the underlying regulatory processes are encoded intracardially, and are thus maintained even in heart transplant recipients. Over the last three decades, molecular substrates of cardiac mechanosensitivity have gained increasing recognition in the scientific and clinical communities. Nonetheless, the processes underlying this phenomenon are still poorly understood. Stretch-activated ion channels (SAC) have been identified as one contributor to mechanosensitive autoregulation of the heartbeat. They also appear to play important roles in the development of cardiac pathologies – most notably stretch-induced arrhythmias. As recently discovered, some established cardiac drugs act, in part at least, via mechanotransduction pathways suggesting SAC as potential therapeutic targets. Clearly, identification of the molecular substrate of cardiac SAC is of clinical importance and a number of candidate proteins have been identified. At the same time, experimental studies have revealed variable–and at times contrasting–results regarding their function. Further complication arises from the fact that many ion channels that are not classically defined as SAC, including voltage and ligand-gated ion channels, can respond to mechanical stimulation. Here, we summarise what is known about the molecular substrate of the main candidates for cardiac SAC, before identifying potential further developments in this area of translational research.
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Affiliation(s)
- Alistair Reed
- Medical Sciences Division, University of Oxford, United Kingdom
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A fatal case of commotio cordis caused by an accidental fall on the beach. J Forensic Leg Med 2013; 21:22-3. [PMID: 24365682 DOI: 10.1016/j.jflm.2013.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Accepted: 10/27/2013] [Indexed: 11/20/2022]
Abstract
Sudden cardiac death is a major health problem and a recurring issue in forensic medicine. Most cases are attributed to congenital heart disease, cardiomyopathy, myocarditis, pathology of the coronary arteries, long or short QT interval syndromes, Brugada syndrome or secondary toxic effects of cardioactive drugs. Sudden death caused by Commotio cordis after an accidental fall is very rare in women. Victims are essentially young people who die following a direct blow to the chest sustained during physical activity. In the following, we report a case of an adult with no significant past medical history, walking on the beach with friends, who died from commotio cordis following an accidental fall on the wet sand. This article deals with post-mortem diagnosis, and demonstrates the importance of a detailed understanding of the circumstances surrounding the death, as well as systematic histological examination of the heart, as the heart will generally appear normal under macroscopic examination. It is important to note that commotio cordis can also occur in adults.
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Quinn TA, Kohl P. Combining wet and dry research: experience with model development for cardiac mechano-electric structure-function studies. Cardiovasc Res 2013; 97:601-11. [PMID: 23334215 PMCID: PMC3583260 DOI: 10.1093/cvr/cvt003] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 01/08/2013] [Accepted: 01/15/2013] [Indexed: 11/17/2022] Open
Abstract
Since the development of the first mathematical cardiac cell model 50 years ago, computational modelling has become an increasingly powerful tool for the analysis of data and for the integration of information related to complex cardiac behaviour. Current models build on decades of iteration between experiment and theory, representing a collective understanding of cardiac function. All models, whether computational, experimental, or conceptual, are simplified representations of reality and, like tools in a toolbox, suitable for specific applications. Their range of applicability can be explored (and expanded) by iterative combination of 'wet' and 'dry' investigation, where experimental or clinical data are used to first build and then validate computational models (allowing integration of previous findings, quantitative assessment of conceptual models, and projection across relevant spatial and temporal scales), while computational simulations are utilized for plausibility assessment, hypotheses-generation, and prediction (thereby defining further experimental research targets). When implemented effectively, this combined wet/dry research approach can support the development of a more complete and cohesive understanding of integrated biological function. This review illustrates the utility of such an approach, based on recent examples of multi-scale studies of cardiac structure and mechano-electric function.
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Affiliation(s)
- T Alexander Quinn
- National Heart and Lung Institute, Imperial College London, Heart Science Centre, Harefield UB9 6JH, UK.
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Maringhini G, Fasullo S, Vitrano G, Terrazzino G, Ganci F, Paterna S, Di Pasqual P. Commotio cordis without arrhythmic event and resuscitation: ECG, echocardiographic, angiographic and cardiovascular resonance imaging study. BMJ Case Rep 2012; 2012:bcr-03-2011-3968. [PMID: 23234817 DOI: 10.1136/bcr-03-2011-3968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a case of commotio cordis in which the patient had an extensive cardiac evaluation, including ECGs, a coronary angiogram, a left ventriculogram, repeated echocardiography and cardiovascular MRI (CMRI). A healthy 17-year-old boy sustained an open-handed blow to the anterior part of the chest from a friend with whom he was playing. On admission ECG was performed that showed ST-T alterations and a TNI increase, with echocardiographic evidence of a localised pericardial effusion associated with a persistent myocardial blush at selective angiography. In addition, CMRI confirmed a local delayed enhancement in the same zone. An echocardiogram examination performed 30 days after discharge showed a complete disappearance of pericardial effusion and an improvement on ECG alterations. This is the first case report of a patient with commotio cordis, who did not show any arrhythmias and did not receive any resuscitation procedure, and was extensively studied by imaging methods.
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Link MS. Commotio cordis: ventricular fibrillation triggered by chest impact-induced abnormalities in repolarization. Circ Arrhythm Electrophysiol 2012; 5:425-32. [PMID: 22511659 DOI: 10.1161/circep.111.962712] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mark S Link
- Cardiac Arrhythmia Service, Department of Medicine, Tufts Medical School, Boston, MA, USA.
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Dau N, Cavanaugh J, Bir C, Link M. Evaluation of injury criteria for the prediction of commotio cordis from lacrosse ball impacts. STAPP CAR CRASH JOURNAL 2011; 55:251-279. [PMID: 22869311 DOI: 10.4271/2011-22-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Commotio Cordis (CC) is the second leading cause of mortality in youth sports. Impacts occurring directly over the left ventricle (LV) during a vulnerable period of the cardiac cycle can cause ventricular fibrillation (VF), which results in CC. In order to better understand the pathophysiology of CC, and develop a mechanical model for CC, appropriate injury criteria need to be developed. This effort consisted of impacts to seventeen juvenile porcine specimens (mass 21-45 kg). Impacts were delivered over the cardiac silhouette during the venerable period of the cardiac cycle. Four impact speeds were used: 13.4, 17.9, 22.4, and 26.8 m/s. The impactor was a lacrosse ball on an aluminum shaft instrumented with an accelerometer (mass 188 g-215 g). The impacts were recorded using high-speed video. LV pressure was measured with a catheter. Univariate binary logistic regression analyses were performed to evaluate the predictive ability of ten injury criteria. A total of 187 impacts were used in the analysis. The criteria were evaluated on their predictive ability based on Somers' D (D) and Goodman-Kruskal gamma (γ). Injury risk functions were created for all criteria using a 2-parameter Weibull distribution using survival analysis. The best criteria for predicting CC were impact force (D=0.52, and γ=0.52) force*compression (D=0.49, and γ=0.49), and impact power (D=0.49, and γ=0.49). All of these criteria proved significant in predicting the probability of CC from projectile impacts in youth sports (p<0.01). Force proved to be the most predictive of the ten criteria evaluated.
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Affiliation(s)
- Nathan Dau
- Wayne State University Bioengineering Center, Detroit, MI 48201, USA.
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Kalin J, Madias C, Alsheikh-Ali AA, Link MS. Reduced diameter spheres increases the risk of chest blow–induced ventricular fibrillation (commotio cordis). Heart Rhythm 2011; 8:1578-81. [DOI: 10.1016/j.hrthm.2011.05.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 05/10/2011] [Indexed: 11/29/2022]
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Juan Ramón Soto S. Dolor torácico. REVISTA MÉDICA CLÍNICA LAS CONDES 2011. [DOI: 10.1016/s0716-8640(11)70478-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Böttiger B. European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2011; 81:1219-76. [PMID: 20956052 DOI: 10.1016/j.resuscitation.2010.08.021] [Citation(s) in RCA: 847] [Impact Index Per Article: 65.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
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Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJLM, Brugger H, Deakin CD, Dunning J, Georgiou M, Handley AJ, Lockey DJ, Paal P, Sandroni C, Thies KC, Zideman DA, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2011; 81:1400-33. [PMID: 20956045 DOI: 10.1016/j.resuscitation.2010.08.015] [Citation(s) in RCA: 362] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
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Solberg EE, Embrå BI, Börjesson M, Herlitz J, Corrado D. Commotio cordis - under-recognized in Europe?: a case report and review. ACTA ACUST UNITED AC 2011; 18:378-83. [PMID: 21450657 DOI: 10.1177/1741826710389363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This case and the review illustrate the induction of a sudden collapse of a football player secondary to a blow to his chest (commotio cordis) [CC]. The article argues that CC probably is under recognized in Europe and cautions that the mounting intensity and speed inherent in modern sports possibly increase the likeliness of CC in the future. If CC occurs, immediate cardiopulmonary resuscitation and automatic external defibrillator should be used.
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Soar J, Perkins G, Abbas G, Alfonzo A, Barelli A, Bierens J, Brugger H, Deakin C, Dunning J, Georgiou M, Handley A, Lockey D, Paal P, Sandroni C, Thies KC, Zideman D, Nolan J. Kreislaufstillstand unter besonderen Umständen: Elektrolytstörungen, Vergiftungen, Ertrinken, Unterkühlung, Hitzekrankheit, Asthma, Anaphylaxie, Herzchirurgie, Trauma, Schwangerschaft, Stromunfall. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1374-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
One of the most important components of mechanoelectric coupling is stretch-activated channels, sarcolemmal channels that open upon mechanical stimuli. Uncovering the mechanisms by which stretch-activated channels contribute to ventricular arrhythmogenesis under a variety of pathologic conditions is hampered by the lack of experimental methodologies that can record the 3-dimensional electromechanical activity simultaneously at high spatiotemporal resolution. Computer modeling provides such an opportunity. The goal of this review is to illustrate the utility of sophisticated, physiologically realistic, whole heart computer simulations in determining the role of mechanoelectric coupling in ventricular arrhythmogenesis. We first present the various ways by which stretch-activated channels have been modeled and demonstrate how these channels affect cardiac electrophysiologic properties. Next, we use an electrophysiologic model of the rabbit ventricles to understand how so-called commotio cordis, the mechanical impact to the precordial region of the heart, can initiate ventricular tachycardia via the recruitment of stretch-activated channels. Using the same model, we also provide mechanistic insight into the termination of arrhythmias by precordial thump under normal and globally ischemic conditions. Lastly, we use a novel anatomically realistic dynamic 3-dimensional coupled electromechanical model of the rabbit ventricles to gain insight into the role of electromechanical dysfunction in arrhythmogenesis during acute regional ischemia.
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Yeh CC, Hsieh CH, Wang YC, Chung PK, Chen RJ. Commotio cordis as a rare cause of traumatic cardiac arrest in motorbike crashes: Report of a case. Surg Today 2010; 40:369-72. [PMID: 20339993 DOI: 10.1007/s00595-008-4073-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2007] [Accepted: 08/12/2008] [Indexed: 11/30/2022]
Abstract
It is futile to attempt resuscitation in a blunt injury patient with no vital signs upon arriving at the emergency department. Therefore, it is recommended that resuscitation be withheld in any blunt trauma patient without vital signs while emergency medical technicians arrive at the scene of the accident. This report presents a case of a blunt torso trauma patient who lost vital signs at the scene and still received cardiopulmonary resuscitation until recovery of spontaneous circulation at the emergency department. The patient was later diagnosed with commotio cordis, and survived to be discharged without any neurological sequelae. Therefore, aggressive resuscitation should be continued until a diagnosis and differential diagnosis of blunt trauma-related cardiac arrest are made by a thorough examination in the emergency department.
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Affiliation(s)
- Chun-Chieh Yeh
- Department of Surgery, Trauma and Emergency Center, China Medical University Hospital, No. 2 Yuh-Der Road, Taichung, 404, Taiwan
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Affiliation(s)
- Barry J Maron
- Hypertrophic Cardiomyopathy Center Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA.
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Ismailov RM. Trauma Associated with Cardiac Conduction Abnormalities: Population-Based Perspective, Mechanism and Review of Literature. Eur J Trauma Emerg Surg 2010; 36:227-32. [PMID: 26815865 DOI: 10.1007/s00068-009-9096-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 09/13/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Various cardiac conduction abnormalities have been described as being a result of trauma in many case reports. The aim of this research was to look at the association between trauma (thoracic and cardiac) and conduction abnormalities in a large hospitalized population. METHODS Cases diagnosed with trauma and various cardiac conduction disorders were identified based on ICD-9-CM discharge diagnoses from 986 acute general hospitals across 33 states in 2001. RESULTS Independent of potential confounding factors, discharge for blunt cardiac injury (BCI) was associated with a threefold increased risk for cardiac conduction abnormalities (95% confidence interval 2.45-4.51) during hospitalization in 2001. Both BCI and thoracic trauma had a significant association with right bundle branch block (RBBB) in this study (OR 6.04; 95% confidence interval (CI) 3.77-9.67 and OR 1.75; 95% CI 1.38-2.23 respectively). CONCLUSIONS The results of this study demonstrate the impact of trauma on cardiac conduction abnormalities. This study represents an attempt to consider a mechanism of a complex traumatic cardiac event from a population-based perspective, and may improve the prognosis for patients diagnosed with cardiac or thoracic injuries.
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Affiliation(s)
- Rovshan M Ismailov
- Department of Population Health, Cancer Care Ontario, Toronto, ON, Canada.
- Department of Population Health, Cancer Care Ontario, 157 Adelaide Street West #275, Toronto, ON, Canada, M5H 4E7.
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Pellis T, Kohl P. Extracorporeal cardiac mechanical stimulation: precordial thump and precordial percussion. Br Med Bull 2010; 93:161-77. [PMID: 20007187 DOI: 10.1093/bmb/ldp045] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION External cardiac mechanical stimulation is one of the fastest resuscitative manoeuvres possible in the emergency setting. Precordial thump (PT), initially reported for treatment of atrio-ventricular block, has been subsequently described to cardiovert also ventricular tachycardia (VT) and fibrillation (VF). PT efficacy, mechanics and mechanisms remain poorly characterized. SOURCES OF DATA Appropriate MESH and free terms were searched on PubMed, Embase and the Cochrane Library. Cross-referencing from articles and reviews, and forward search using SCOPUS and Google scholar have also been performed. Pre-set inclusion and exclusion criteria were applied to retrieved references on PT, which were then reviewed, summarized and interpreted. AREAS OF AGREEMENT PT is not effective in treating VF, and of limited use for VT, although it has a very good safety profile (97% no changed/improved rhythm). If delivered, PT should be applied as early as possible after cardiac arrest, and cardio-pulmonary resuscitation (CPR) should begin with no delay if not effective. AREAS OF CONTROVERSY A relatively large fraction of reported positive outcomes (both for PT and the less forceful but serially applied precordial percussion) in witnessed asystole should be considered when critically reviewing present CPR recommendations. In addition, mechanisms, energy requirements and timing are analysed and discussed. GROWING POINTS AND AREAS TIMELY FOR DEVELOPING RESEARCH The 2005 ALS guidelines recommend PT delivery only by healthcare professionals trained in the technique. The use of training aids should therefore be explored, regardless of whether they are based on stand-alone devices or integrated within resuscitation mannequins.
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Affiliation(s)
- Tommaso Pellis
- Emergency Medical Service, Anaesthesia and Intensive Care, Santa Maria degli Angeli Hospital, Via Monterale 24, Pordenone, Italy.
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Miyazaki T, Ihama Y, Fuke C. An autopsy case of commotio cordis from a motor scooter accident. Leg Med (Tokyo) 2008; 10:264-7. [DOI: 10.1016/j.legalmed.2008.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Revised: 12/28/2007] [Accepted: 01/13/2008] [Indexed: 11/16/2022]
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Abstract
Sudden cardiac death in athletes is an uncommon but extremely visible event because of the high profile of amateur and professional athletes and the expected excellent health of these athletes. However, paradoxically, athletic performance may immediately increase the risk of ventricular arrhythmias and sudden cardiac death while run reducing atherosclerosis, which thus improves cardiovascular health and longevity. In athletes younger than 30 years, the most common underlying causes are due to inherited heart disease. In the older athletes, sudden death is generally due to arrhythmias in the context of coronary artery disease. Many athletes with aborted sudden death, arrhythmia-related syncope, or high-risk genetic disorders benefit from therapy with implanted cardioverter/defibrillators (ICDs) . Although ICD therapy can effectively abort sudden death, implantation of an ICD generally prohibits an individual from all competitive athletics except low-intensity sports. The screening of athletes has been notoriously inadequate; however, the optimal screening strategies have yet to be determined. Recommendations for participation in competitive athletics generally follow the recently published 36th Bethesda Conference Eligibility Recommendations for Competitive Athletes with Cardiovascular Abnormalities.
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Affiliation(s)
- Mark S Link
- Division of Cardiology, Cardiac Arrhythmia Service, Tufts-New England Medical Center, Boston, MA 02111, USA.
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Lucena JS, Rico A, Salguero M, Blanco M, Vázquez R. Commotio cordis as a result of a fight: Report of a case considered to be imprudent homicide. Forensic Sci Int 2008; 177:e1-4. [DOI: 10.1016/j.forsciint.2007.09.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 01/23/2007] [Accepted: 09/17/2007] [Indexed: 11/29/2022]
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The Spectrum of Findings in Cases of Sudden Death Due to Blunt Cardiac Trauma—‘Commotio Cordis’. Am J Forensic Med Pathol 2008; 29:1-4. [DOI: 10.1097/paf.0b013e31815b4d37] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ismailov RM, Ness RB, Redmond CK, Talbott EO, Weiss HB. Trauma Associated With Cardiac Dysrhythmias: Results From a Large Matched Case-Control Study. ACTA ACUST UNITED AC 2007; 62:1186-91. [PMID: 17495723 DOI: 10.1097/01.ta.0000215414.35222.bb] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Various cardiac dysrhythmias such as supraventricular and ventricular premature beats, supraventricular and ventricular paroxysmal tachycardia, atrial and ventricular fibrillation and atrial flutter have been reported in case series, as complications of blunt cardiac and thoracic trauma. The objective of this research was to determine whether thoracic or blunt cardiac injury is associated with cardiac dysrhythmia in a large multistate hospitalized population. METHODS Cases and matched (by age) controls were identified based on hospital discharge information that was collected from 986 acute general hospitals across 33 states in 2001. Both the exposure (thoracic trauma and blunt cardiac injury) and the outcome (cardiac dysrhythmias) were identified based on ICD-9-CM discharge diagnoses. Unadjusted and conditional adjusted (for gender, race, length of stay, and primary source of payment) multivariate logistic regression analyses were performed. RESULTS After adjusting for potential confounders, patients 50 years and younger diagnosed with blunt cardiac injury had a fourfold (95% confidence interval, 1.40-11.60) increase in the risk of cardiac dysrhythmia. Independent of potential confounding factors, discharge for blunt cardiac injury among patients 51 to 70 years old was associated with a twofold (95% confidence interval, 1.36-3.82) increased risk for cardiac dysrhythmia. CONCLUSION Blunt cardiac injury was found to be a significant risk factor for cardiac dysrhythmia. Longitudinal studies are needed to better establish the association between trauma and cardiac dysrhythmias.
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Affiliation(s)
- Rovshan M Ismailov
- Bio Med Center for Population Health and Clinic Epidemiology, Brown University, Providence, RI 02940, USA.
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Madias C, Maron BJ, Weinstock J, Estes NAM, Link MS. Commotio cordis--sudden cardiac death with chest wall impact. J Cardiovasc Electrophysiol 2007; 18:115-22. [PMID: 17229310 DOI: 10.1111/j.1540-8167.2006.00684.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Commotio cordis (CC), sudden death as a result of a blunt, often innocent-appearing chest wall blow, is being reported with increasing frequency. The clinical spectrum is diverse; however, a substantial number of cases occur in youth athletics. In events that occur during sport, victims are struck by projectiles regarded as standard implements of the game. Sudden death is instantaneous and victims are most often found in ventricular fibrillation (VF). Overall survival is poor; however, successful resuscitation can be achieved with early defibrillation. Autopsy is notable for the absence of any significant cardiac or thoracic injury. Development of an experimental model has allowed for substantial insights into the underlying mechanisms of sudden death. In anesthetized juvenile swine, induction of VF is instantaneous following chest wall blows occurring during a vulnerable window before the T wave peak. Crucial variables including the velocity of impact, impact location, and hardness of the impact object have been identified. Rapid left ventricular (LV) pressure rise following chest impact likely results in activation of ion channels via mechano-electric coupling. The generation of inward current via mechano-sensitive ion channels likely results in augmentation of repolarization and nonuniform myocardial activation, and is the cause of premature ventricular depolarizations that are triggers of VF in CC. While softer-than-standard safety baseballs reduce the risk of CC, commercially available chest protectors are ineffective in preventing CC. The development of more effective chest protectors and more widespread use of automated external defibrillators at youth sporting events are needed.
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Affiliation(s)
- Christopher Madias
- Cardiac Arrhythmia Center, Division of Cardiology, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA
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