| T O P I C R E V I E W |
| Karl |
Posted - Jan 18 2005 : 07:44:30 AM
What is a Heart Concussion?
Sudden death following a direct but seemingly harmless blow to the chest is a rare yet disturbing condition known as "commotio cordis" or "concussion of the heart." Although commotio cordis is considered rare by many authors, it represents one of the most common mechanisms of sudden death in sport seen in young athletes. Sports with the greatest incidence of this condition include baseball, hockey and lacrosse, but cases of this condition have presented themselves on the soccer field.
A heart concussion is defined as an instantaneous cardiac arrest produced by a non-penetrating chest blow to the chest wall or heart in the absence of heart disease or congenital abnormality. This condition usually occurs in young males that participate in athletic activities. A study outlining the characteristics of 70 patients affected by this condition show an average age of 12 yrs, all were male except one and 90% were participating in an athletic event at time of onset causing fibrillation of the heart muscle.
Such fatalities obviously bring a great deal of media attention and legal debate to the topic and force regulating bodies to regularly reassess their safety parameters whenever an incident of this type arises. Efforts have been made to utilise softer baseballs for children and require additional protective equipment. Experts report however that because these incidents are so rare, it would not be cost effective to mandate additional protective equipment.
Kids control the ball with their chest all of the time! How does a ball hitting a child's chest cause them to die?
Researchers have shown that there are four components to the physiology behind this trauma causing death.
1) Type of Impact : Swift impact to a very small area
2) Location of Impact : Left edge/mid sternum or directly over the medial portion of the heart
3) Force of Impact : Moderate to large force (peaked at 40 mph)
4) Timing of Impact : There is a vulnerable period in the heart rhythm right after the beat takes place when the heart is repolarizing (getting ready) for the next beat. The scientists could recreate the cardiac arrest if the blow came in this 15 – 30 millisecond window.
When the force impacts the chest at exactly the right time, the heart immediately goes into ventricular fibrillations and it seems unable to recover form the impact.
There have been cases of near misses that do not result in death. If the blow takes place just outside of the 30 millisecond window, the athlete may go unconscious and not go into ventricular fibrillations.
What can be done to prevent this from happening and if it does happen, what can I do?
This condition was first reported in 1857.
Unfortunately, if this condition takes place on a sporting field, the player is very difficult to resuscitate. Getting an ambulance to the site as quickly as possible is what must take place in most on field situations. The only tool that has been proven to revive these patients effectively is an AED (automated external defibrillator). At this time, AED devices are not accessible to most athletic facilities in Canada, but this may change with time as they are becoming very accessible. In the mean time, it is recommended that 911 be called and CPR/First Aid be administered to the player immediately until EMS arrives.
Fortunately, this is a very rare condition. It is important for the soccer coach and staff however, to be aware of this topic, as when this condition presents itself in the news (anywhere in the world), a barrage of questions will be coming from concerned parents.
REFERENCES
Curfman D. Fatal impact: concussion of the heart. N Engl J Med 1998;338:1841–3
Maron BJ, Poliac LC, Kaplan JA, Mueller FO. Blunt impact to the chest leading to a sudden death from cardiac arrest during sports activities. N Engl J Med 1995; 333: 337-42.
Maron BJ, Link MS, Wang PJ, Estes NAM III. Clinical profile of commotio cordis: an under appreciated cause of sudden death in the young during sports and other activities. J Cardiovasc Electrophysiol 1999; 10: 114-20.
McCrory, P. Commotio Cordis. Br J Sp Med 2002; 36:236-237.
Nesbitt AD, Cooper PJ, Kohl P. Rediscovering commotio cordis. Lancet 2001;357:1195–7
Zachazewski J, Magee D, Quillen W. Athletic Injuries and Rehabilitation. Saunders, 1996
Post by OJ in the Reggae Boyz Forum - Jan. 17, 2004 at 10:55:03 PM |
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