Commotio cordis

The incidence of cardiac injury after blunt chest trauma is difficult to determine and ranges from 8% to 76%. Moreover, the clinical presentation varies tremendously without a real gold standard to exclude or document cardiac involvement. Electrocardiogram as a single test is not sensitive or specific for diagnosing cardiac contusion. Furthermore, creatine kinase MB is non-reliable in the setting of severe trauma involving the liver, intestines or diaphragm. Although troponins T and I are highly specific for cardiac injury, their sensitivity in the setting of trauma is poor. The echocardiogram is very useful in the evaluation of trauma patients with suspected cardiac involvement. However, poor windows in the setting of chest and lung injuries and in intubated patients might be a major problem limiting the accuracy of transthoracic echocardiogram. On the other hand, transesophageal echocardiogram seems to be more sensitive and specific in trauma patients and should be the test of choice in patients with high clinical suspicion for blunt cardiac trauma.

Although it is very rare for a normal child to have a true cardiac emergency, nonetheless, parents often come to the emergency department because they worry that their child might have a serious cardiac problem. This article will review common emergency department presentations in children that raise the concern for heart disease and clues that may indicate the presence of cardiac-related disorders.

Ventricular fibrillation and sudden death triggered by a blunt, nonpenetrating, and often innocent-appearing unintentional blow to the chest without damage to the ribs, sternum, or heart (in the absence of underlying cardiovascular disease) constitute an event known as commotio cordis. This review provides information on the clinical profile of this event, the physiological mechanisms underlying it, and steps that can be taken to prevent the event and to resuscitate the victim, should it occur.

This review provides information on the clinical profile of commotio cordis, the physiological mechanisms underlying it, and steps that can be taken to prevent the event and to resuscitate the victim, should it occur.

Ventricular fibrillation and sudden death triggered by a blunt, nonpenetrating, and often innocent-appearing unintentional blow to the chest without damage to the ribs, sternum, or heart (and in the absence of underlying cardiovascular disease) constitute an event known as commotio cordis, which translates from the Latin as agitation of the heart. This term was first used in the 19th century,1, 2, 3, 4, 5, 6 although the occurrence of commotio cordis was described earlier, in accounts of the ancient Chinese martial art of Dim Mak (or touch of death), in which blows to the left of the sternum caused sudden death in opponents.⁷ An . . .