Commotio Cordis

What is commotio cordis?

Commotio cordis is a condition in which an abnormal heart rhythm (ventricular fibrillation) and cardiac arrest happen immediately upon an object (usually something small and hard like a baseball or hockey puck) striking the chest directly over the heart at a very critical time during a heartbeat.

With commotio cordis (Latin for “agitation of the heart”), the impulse from the object disrupts the normal heart rhythm and leads to sudden cardiac arrest.

How common is commotio cordis?

Cases of commotio cordis are extremely rare. There are fewer than 30 cases each year.

Can you survive commotio cordis?

Yes, you can survive commotio cordis if you receive cardiopulmonary resuscitation (CPR) and defibrillation right away. The odds of survival have improved greatly over time as more people recognize the condition, provide CPR and have automated external defibrillators (AEDs) available.

What are the symptoms?

Commotio cordis symptoms include:

• Collapse immediately after getting hit in the chest.
• Ventricular fibrillation.
• Cardiac arrest.
• Unconsciousness.

What causes commotio cordis?

Getting hit at a 90-degree angle on the left side of your chest directly over the heart with a baseball or other small, hard sports equipment can cause commotio cordis. Your heart is on the left side of your chest. You could get commotio cordis from a baseball, lacrosse ball or hockey puck that comes straight at your chest at 40 mph or 50 mph, for example.

Can a punch cause commotio cordis?

Yes, a punch can cause commotio cordis. However, it would have to be coming at you at a 90-degree angle at 40 mph or more. And it would have to happen at just the right time in your cardiac cycle.

What happens during commotio cordis?

The unexpected blow right where your heart is can cause ventricular fibrillation and then sudden cardiac arrest. This can happen if you get hit during the very short time when your lower heart chambers (ventricles) are relaxing after a contraction (heartbeat). The force of the blow can make your ventricles contract when they’re supposed to be resting.

What are the risk factors for commotio cordis?

Commotio cordis happens most often to people who:

• Play sports, especially those involving a baseball or another hard object (commonly a lacrosse ball, softball or hockey puck).
• Are younger than age 20 (average age of around 15).
• Are male or assigned male at birth (AMAB).

What are the complications of commotio cordis?

Cardiac arrest from commotio cordis can be fatal. According to the National Commotio Cordis Registry, this condition has caused sudden death in more than 220 people since 1996, when the registry began.

How is commotio cordis diagnosed?

A healthcare provider may suspect commotio cordis if someone collapses after getting hit in the left side of the chest with a hard, fast-moving baseball or hockey puck. With this suspicion, they can do testing in a hospital after giving the person CPR and defibrillation.

What tests will be done to diagnose commotio cordis?

Importantly, commotio cordis is a diagnosis of exclusion. A provider excludes more common causes of cardiac arrest before confirming this as a diagnosis. Tests to help diagnose commotio cordis include:

• Electrocardiogram (EKG).
• Blood tests.
• Echocardiogram.
• Heart MRI or CT scan.
• Heart catheterization.

How is commotio cordis treated?

A person with commotio cordis needs immediate medical attention for cardiac arrest. Ask someone to call 911 while you provide CPR. Emergency care should include the use of an AED.

After receiving emergency treatment, the person should have a complete evaluation for undiagnosed heart issues.

Healthcare providers will admit someone with commotio cordis to the hospital, where they’ll monitor them. They’ll use imaging to check how well their heart functions.

Specific procedures used

Providers may use therapeutic hypothermia for adult survivors of commotio cordis who can’t follow commands. This treatment can help your brain use oxygen more slowly and prevent swelling in your brain.

A provider sedates you and puts in a breathing tube before cooling you for 12 to 24 hours. They can use a cooling machine, ice packs, cold IV fluids and cooling blankets to keep your body temperature at 89.6 to 93.2 degrees Fahrenheit (32 to 34 degrees Celsius). Afterward, they rewarm you for several hours.

Complications/side effects of commotio cordis treatment

Therapeutic hypothermia can cause:

• Pneumonia.
• Sepsis.
• Abnormal heart rhythms.
• Coagulopathy (blood is less able to form clots).

How can I lower my risk of commotio cordis?

Although protective gear hasn’t prevented commotio cordis completely, it may provide some protection. And sports teams can use baseballs that are safer for younger athletes. Most importantly, coaches and other staff can get training on how to recognize commotio cordis when it happens and how to do CPR when it does. They can also make sure that their sports venues have functional and accessible AEDs. A well-planned and rehearsed emergency action plan (EAP) is vital for prompt treatment.

What can I expect if I have commotio cordis?

If healthcare providers evaluate you and don’t find any heart issues, you won’t need treatment after you recover from commotio cordis. However, if they find that you have a congenital (since birth) or genetic heart issue that you didn’t know you had, you may need treatment for that.

When can I go back to playing sports?

You may be able to return to playing sports after you’ve had a complete evaluation of your heart. This may include:

• Electrocardiogram (EKG).
• Echocardiogram.
• Heart MRI or CT.
• Stress test.

A provider may not recommend playing sports again if you have heart issues. There’s a small risk of commotio cordis happening again, so you may need to avoid sports that could damage your chest.

Outlook for commotio cordis

Commotio cordis is a known cause of sudden cardiac death in young people who play sports. It’s second only to hypertrophic cardiomyopathy. Prompt treatment improves your chances of survival, which is about 59%. Those who don’t receive CPR right away or have a congenital (since birth) heart issue are less likely to survive.

How do I take care of myself?

If a heart specialist (cardiologist) who examined you didn’t find any heart issues, you most likely won’t need follow-up care. However, if they discovered a heart issue you didn’t know you had, you’ll need treatment for it.

Even if you don’t have a heart condition, you should see a provider every year for a checkup.

When should I go to the ER?

If you have a heart condition, you may need emergency care again at some point.

Someone nearby should call 911 if you experience:

• Chest pain.
• Heart palpitations.
• Shortness of breath.
• Lightheadedness.
• Passing out.

What questions should I ask my doctor?

Questions to ask your provider may include:

• Do I have any heart issues that require care?
• Can I play contact sports again?
• How can I protect myself from another chest injury?

A note from Cleveland Clinic

Getting hit in the chest is a traumatic event, but the odds of survival after commotio cordis are higher than ever today. With prompt medical attention, many people can recover. If a provider finds a cardiac issue, be sure to follow their recommendations for follow-up care. CPR training and AED availability may provide peace of mind for people playing a sport that puts them at risk for commotio cordis.