Cardio Case Challenge: A 17-Year-Old in Cardiac Arrest After Collision Playing Sports

Jansen Tiongson, MD; Lisa Chan, MD


December 16, 2022


Commotio cordis (which is Latin for "disturbance of the heart") is, in essence, a concussion of the heart. Initially described as early as 1857, it is defined as an instantaneous cardiac arrest produced by a witnessed, nonpenetrating blow to the chest, in the absence of preexisting heart disease or identifiable morphologic injury to the sternum, ribs, chest wall, or heart. Commotio cordis is a diagnosis of exclusion. Other causes, such as myocardial infarction, electrolyte abnormality, long-QT syndrome, and hypertrophic obstructive cardiomyopathy (HOCM), must first be ruled out with examinations such as serial assessment of cardiac biomarkers and electrocardiography, electrolyte level testing, and echocardiography.[1,2]

Commotio cordis is believed to be underreported and underrecognized. Less than 30 cases are reported each year.[2] The vast majority of cases (95%) occur in boys. The mean age is 15 years, with few cases reported in individuals older than 20 years. This may be due to the fact that protection of the heart by subcutaneous fat, muscle bulk, and fully ossified ribs all become more common in adulthood.[2,3]


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