Abstract

death following a sharp butseemingly inconsequential blow tothe chest is a frightening occur-rence known as “commotio cordis ” or “concussion of the heart. ” Although commotio cordis is considered rare by some authors, it represents one of the most common mechanisms of sudden death in sport seen in young athletes.1 Commotio cordis is generally under-stood to mean “instantaneous cardiac arrest produced by non-penetrating chest blows in the absence of heart disease or identifiable morphologic in-jury to the chest wall or heart”.2 3 Most cases report accidental death of other-wise healthy children or adolescents after chest impact during recreational or competitive sport or, less commonly, during road traffic accidents.4–9 Such fatalities receive extensive media coverage, provoke legal debate, and may stimulate research into the public health aspects of this condition—for example, the capacity of protective gear to prevent commotio cordis or the possibility of developing safer sporting equipment.10 HISTORY The current concept of commotio cordis is often ascribed to a review of 70 cases by Maron et al.2 Their report portrays commotio cordis as a rare but dangerous condition in which there is usually a poor response to resuscitatory measures. Most of those affected were young (mean age 12 years), male (all but one), and, at the time of accident, engaged in sport (>90%). The event leading to sud-den death was a precordial impact, most commonly by projectiles such as base-balls, softballs, or hockey pucks, probably occurring during an electrically vulner-able phase of the cardiac cycle.11 Interestingly, the term commotio cordis was in use as early as 1857.12 13 A review from 1896 shows that the term was applied to various forms (both lethal and non-lethal) of cardiovascular disor-der caused by mechanical impact to the chest (both in the presence and absence of minor cardiac bruising).14 Commotio cordis underwent a con-ceptual modification at the turn of the century whereby a distinction between non-penetrating precordial impact in the presence (contusion) or absence (com-motion) of cardiac bruising was established.15 In many ways, the concept of commotio cordis paralleled that of commotio cerebri (brain concussion) for which the issue of structural injury has been controversial since the early 1700s and terminological inexactitude has plagued the medical literature up to the present day.16