RESUMO
Nonpenetrating blunt force trauma to the front of the chest can lead to commotio cordis, a cardiac rhythm disturbance, which can result in cardiac arrest and death. The condition is particularly noted during sport. No series of such cases has been published in the UK. This study is a retrospective analysis of a database of 6000 cases of sudden cardiac death examining commotio cordis in the setting of collapse and death shortly following a blow to the precordium where no structural heart disease was identified at autopsy. Of the 17 cases, 16 were male, and 11 were 18 years old or younger. Eleven occurred whilst playing sport while 6 involved physical interaction including assault. The most common circumstance of death involved a youth being struck in the chest by a ball during sporting activity. In conclusion, this study demonstrates that cases of commotio cordis in the UK follow a similar circumstantial and age profile to those reported in the United States, and indicates that ball sports such as football, cricket, and rugby expose young participants to a similar risk. There is currently no nation-wide registry of deaths occurring during sporting activity in the UK, and although the true incidence of this condition is not currently known, it is most probably under-recognised and underdiagnosed.
Assuntos
Traumatismos em Atletas/mortalidade , Commotio Cordis/mortalidade , Morte Súbita Cardíaca/etiologia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/mortalidade , Adolescente , Traumatismos em Atletas/diagnóstico , Estudos de Coortes , Commotio Cordis/etiologia , Críquete/lesões , Morte Súbita Cardíaca/epidemiologia , Feminino , Futebol Americano/lesões , Humanos , Incidência , Masculino , Sistema de Registros , Estudos Retrospectivos , Traumatismos Torácicos/mortalidade , Reino Unido , Ferimentos não Penetrantes/complicações , Adulto JovemAssuntos
Commotio Cordis/terapia , Morte Súbita Cardíaca/prevenção & controle , Cardioversão Elétrica , Ressuscitação , Traumatismos Torácicos/terapia , Fibrilação Ventricular/terapia , Ferimentos não Penetrantes/terapia , Animais , Commotio Cordis/diagnóstico , Commotio Cordis/mortalidade , Commotio Cordis/fisiopatologia , Morte Súbita Cardíaca/etiologia , Desfibriladores , Cardioversão Elétrica/instrumentação , Humanos , Fatores de Risco , Traumatismos Torácicos/diagnóstico , Traumatismos Torácicos/fisiopatologia , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/mortalidade , Fibrilação Ventricular/fisiopatologia , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/mortalidade , Ferimentos não Penetrantes/fisiopatologiaAssuntos
Morte Súbita Cardíaca/epidemiologia , Morte Súbita Cardíaca/prevenção & controle , Esportes , Adolescente , Displasia Arritmogênica Ventricular Direita/mortalidade , Atletas , Síndrome de Brugada/mortalidade , Cardiomiopatias/mortalidade , Commotio Cordis/mortalidade , Anomalias dos Vasos Coronários/mortalidade , Morte Súbita Cardíaca/etiologia , Feminino , Displasia Fibromuscular/mortalidade , Humanos , Hipertrofia Ventricular Esquerda/mortalidade , Síndrome do QT Longo/mortalidade , Masculino , Síndrome de Marfan/mortalidade , Programas de Rastreamento/métodos , Anamnese , Miocardite/mortalidade , Exame Físico , Instituições Acadêmicas , South Carolina/epidemiologia , Taquicardia Ventricular/mortalidadeAssuntos
Comitês Consultivos , American Heart Association , Atletas , Cardiologia/normas , Anormalidades Cardiovasculares/diagnóstico , Commotio Cordis/diagnóstico , Adolescente , Adulto , Anormalidades Cardiovasculares/mortalidade , Criança , Commotio Cordis/mortalidade , Feminino , Humanos , Masculino , Guias de Prática Clínica como Assunto/normas , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Commotio cordis events due to precordial blows triggering ventricular fibrillation are a cause of sudden death (SD) during sports and also daily activities. Despite the absence of structural cardiac abnormalities, these events have been considered predominantly fatal with low survival rates. OBJECTIVE: To determine whether expected mortality rates for commotio cordis have changed over time, associated with greater public visibility. METHODS: US Commotio Cordis Registry was accessed to tabulate frequency of reported SD or resuscitated cardiac arrest over 4 decades. RESULTS: At their commotio cordis event, 216 study patients were 0.2-51 years old (mean age 15±9 years); 95% were males. Death occurred in 156 individuals (72%), while the other 60 (28%) survived. Proportion of survivors increased steadily with concomitant decrease in fatal events. For the initial years (1970-1993), 6 of 59 cases survived (10%), while during 1994-2012, 54 of 157 (34%) survived (P = .001). The most recent 6 years, survival from commotio cordis was 31 of 53 (58%), with survivor and nonsurvivor curves ultimately crossing. Higher survival rates were associated with more prompt resuscitation (40%<3 minutes vs 5%>3 minutes; P<.001) and participation in competitive sports (39%; P<.001), but with lower rates in African Americans (1 of 24; 4%) than in whites (54 of 166; 33%; P = .004). Independent predictors of mortality were black race (P = .045) and participation in noncompetitive sports (P = .002), with an on-site automated external defibrillator use protective against SD (P = .01). CONCLUSIONS: Survival from commotio cordis has increased, likely owing to more rapid response times and access to defibrillation, as well as greater public awareness of this condition.
