[Commotio cordis]. / Commotio cordis.

Blunt, non-penetrating trauma of the chest (commotio cordis) can cause sudden death in individuals without known cardiac disease. Sudden death in commotio cordis is due to ventricular fibrillation. The timing of the blow must be during the electric vulnerable period of the ECG cyclus, 10-40 milliseconds before the peak of the T-wave. The risk of arrhythmia increases progressively, until a velocity of 64 km/h, and at higher velocities the risk of ventricular fibrillation begins to diminish. The location of the impact must be directly over the cardiac silhouette.