Commotio Cordis

What is commotio cordis?

Commotio cordis is an extremely rare, serious medical condition that can happen after a sudden, blunt impact to the chest. If the physical blow hits during a narrow window in the heart rhythm, it can disrupt the heartbeat and cause sudden cardiac arrest.

Commotio cordis (pronounced ke-MO-she-o-KORD-is) is not linked to underlying cardiac issues or heart disease. It is often fatal, but lifesaving measures including CPR and the use of an automated external defibrillator (AED) can increase survival rates.

There are fewer than 10 new cases reported each year, but commotio cordis became widely known after many suspected it might have caused Damar Hamlin’s cardiac arrest in January. On April 18, Hamlin said he was indeed diagnosed with commotio cordis.

This condition is most common in young male athletes. It is frequently caused by baseballs, softballs, lacrosse balls, hockey pucks or physical contact from other athletes

What causes commotio cordis?

Commotio cordis occurs as a result of a blow to the left side of the chest during a narrow window in the heart rhythm.

Baseball has generated the most instances of commotio cordis. Harder, round objects such as baseballs, softballs, lacrosse balls and hockey pucks are more likely to trigger commotio cordis. In a smaller number of cases, commotio cordis is the result of other types of physical trauma such as car accidents or assault.

What are the risk factors for commotio cordis?

There are no specific risk factors for commotio cordis. Many reported cases have occurred in young male athletes between the ages of 11 and 20, and very few have been reported for people over age 20. Experts believe it is more common in younger people due to their thinner, less developed chest wall. It is also suspected that cases are higher in a younger demographic because fewer adults typically participate in sports such as baseball, lacrosse and hockey.

While rare, it is one of the most frequent causes of death in young athletes. But researchers believe it may be an underreported medical condition.

What are the symptoms of commotio cordis?

The symptoms may include:

Sudden collapse, though a person may be able to remain active for several seconds before collapsing.
Lack of responsiveness.
No breath, pulse or heartbeat.

How should you respond to commotio cordis?

If you think someone could be suffering from a cardiac arrest caused by commotio cordis, immediately start an emergency medical response. These three critical steps in the chain of survival could save a life:

Call 911.
Begin CPR. If the person isn’t breathing or is only gasping, begin CPR with compressions by pressing hard and fast on the center of the chest. Continue CPR until the person starts to breathe or move, or until someone with more advanced training takes over.
Use an AED. Use a defibrillator to shock the heart back into normal rhythm.

How do you treat commotio cordis?

The most important way to treat commotio cordis is to immediately recognize the issue and start an emergency medical response. This includes calling 911, beginning CPR and using an AED to get the heart beating normally again. The current survival rate for commotio cordis is above 50%, and the rapid initiation of CPR and an AED is the most critical way to save someone’s life after commotio cordis. An AED must be used within 3-5 minutes for the highest chance of survival.

How can you prevent commotio cordis?

It is difficult to eliminate all risk of commotio cordis, especially for athletes or people who engage in recreational activities with a chance of physical contact. But you can do a few important things to prevent commotio cordis and improve the outlook for anyone who experiences it.

Learn the critical signs of commotio cordis so you can initiate the chain of survival that could save someone’s life: calling 911, administering CPR and using an AED.
Keep an AED on hand at athletic and recreational facilities. An AED could increase the odds of survival in the event of commotio cordis.
Train coaches and other athletic personnel, teachers, parents and students in CPR.
Adapt your athletic activities and learn safe playing techniques to avoid hard blows to the chest. For example, if you’re playing baseball and up at bat, turn your body away from any pitches that could hit your chest. If you’re playing defense in lacrosse or hockey, avoid using your chest to block the ball or puck.
Use safety baseballs or t-balls, especially for younger children, which are softer and more flexible than standard baseballs.

What is the difference between commotio cordis and sudden cardiac arrest?

Commotio cordis and sudden cardiac arrest both involve a cardiac arrest. A big difference is what causes the cardiac arrest. Commotio cordis is caused by a blunt impact to the chest during a narrow window of the heartbeat, when the heart is preparing to contract, which triggers cardiac arrest.

Sudden cardiac arrest happens when the heart stops beating normally. It may be linked to heart disease or other factors that cause the heart’s electric system to malfunction.

How do you stay healthy after commotio cordis?

There is no evidence that survivors of commotio cordis are at a higher risk for other heart events. And it’s extremely unlikely that someone would suffer two instances of commotio cordis. If you’ve experienced commotio cordis, you should consult with your doctor about a safe return to physical activity. Survivors should undergo a complete cardiac evaluation to rule out heart disease. This may include an electrocardiogram or ECG, echocardiogram, cardiac imaging and stress testing.

Commotio cordis videos

Written by American Heart Association editorial staff and reviewed by science and medicine advisors.

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Last Reviewed: Apr 17, 2023