Commotio cordis: an underappreciated cause of sudden death in athletes

Death due to coronary artery insufficiency following blunt trauma to the chest

There have been numerous reports of sudden cardiac death following blunt trauma to the chest, but there is lack of such references in forensic literature. It is the court of law which makes decision about trauma precipitating natural events. The forensic pathologist is scientifically trained in the medical field and would be in a better position to give clear picture about the victim's general status at the time of death, exact nature and severity of the illness he is suffering from if any. He can also assess the nature and severity of injuries sustained, and thus, his opinion as to the possible role played by the traumatic event in bringing about the death is valuable. This paper will discuss the mechanism of cardiac injury or possible cardiac injury and sudden death of an apparently healthy 36-year-old male following blunt chest trauma sustained during alleged assault by his neighbor.

Cardiac concussion (commotio cordis)

Blunt chest trauma in pediatric patients can result in various injuries to the myocardium. Cardiac concussion (commotio cordis) is seen in patients in whom the precordium has been struck with relatively little force at a vulnerable period of the cardiac cycle. These patients have no predisposing cardiac problems, and autopsy reveals no evidence of heart damage. The usual clinical presentation is that of immediate collapse secondary to a lethal arrhythmia. Prevention is the cornerstone of potentially decreasing the incidence with the aid of safety equipment and, possibly, immediate defibrillation.

Sudden cardiac death in the active adult: causes, screening, and preventive strategies

Cardiovascular disease is the most frequent cause of death among Americans today and unfortunately is not limited to the elderly and those with various comorbidities, but also takes the lives of young, seemingly healthy individuals, including elite athletes. Because of the tremendous social and psychologic impact that these albeit rare events entail, there has been a drive in recent years to develop preventive strategies so that such tragedies may be avoided. It is also imperative that recommendations be made for those older individuals with existing disease who wish to remain active and healthy. If such individuals are to engage in such activities they must know the risks involved. This review defines the spectrum of cardiac disease commonly affecting athletes and presents the most current diagnostic strategies as well as recommendations for disqualification from sport. In addition, it is important to recognize the benefits of regular physical activity even in those older patients at risk because of existing heart disease and provide them with adequate information regarding the extent to which they may participate in physical activity.

Commotio cordis

Commotio cordis is ventricular fibrillation that results from blunt chest trauma and is a life threatening condition; early resuscitation and defibrillation are critical. This may occur during sporting events or from child abuse and most patients are boys who are younger than 16 years. Commotio cordis' prognosis depends on the availability of cardiac defibrillation. Automatic defibrillators at convenient locations near sporting events, combined with improved cardiopulmonary resuscitation education, may improve chances of survival after this rare phenomenon. Transient cardiac conduction abnormalities and arrhythmias have been observed in survivors; therefore, cardiac clearance before resumption of sports is indicated.

Recreational injuries in children: incidence and prevention

Participation in eight common types of recreational activities leads annually to more than 2 million medically treated musculoskeletal injuries in children aged 5 to 14 years. Many of these injuries could have been prevented if current safety guidelines and protective equipment had been used. Studies have demonstrated the value of safety education programs in preventing injuries. Parents consider their child's physician an important source of safety education, and orthopaedic surgeons have a unique opportunity to provide injury prevention counseling. The American Academy of Orthopaedic Surgeons recognizes the importance of injury prevention and has developed advocacy programs that are readily available to physicians and the public. Individual orthopaedists should be involved in injury prevention through patient education, research, community programs, and regulatory efforts that promote safe play for children.