What Causes Commotio Cordis?

Medically Reviewed on 2/13/2023
When treatment is administered promptly, a person's chances of surviving commotio cordis increases to 59 percent.
When treatment is administered promptly, a person’s chances of surviving commotio cordis increase to 59 percent.

In most cases, the cause of commotio cordis is an abnormal heart rhythm and cardiac arrest caused by being hit by an object, such as a baseball, hockey puck, or lacrosse ball, on the left side of the chest. When some object hits the chest, it affects the normal rhythm of the heart.

A direct 90° hit on the left side of the chest over the heart with a baseball or other small, hard sports objects coming straight at 40 or 50 mph results in commotio cordis. Moreover, a punch to the chest, coming at 40 mph or faster, can cause commotio cordis.

  • Commotio cordis occurs rarely; only 30 or fewer cases are reported each year.
  • Commotio cordis may be the leading cause of death in young athletes. Children, especially boys aged 15 years, are at a high risk of commotio cordis.

Immediate CPR may help survive commotio cordis. The odds of survival have improved over the years as people are aware of the symptoms and the availability of external defibrillators has increased.

What are the symptoms of commotio cordis?

Symptoms of commotio cordis include the following:

  • Ventricular fibrillation
  • Unconsciousness
  • Collapse, immediately after getting hit
  • Cardiac arrest

What happens during commotio cordis?

A sudden unexpected hit on the chest can cause ventricular fibrillation and then result in cardiac arrest. This occurs when the ventricles (lower chambers of the heart) relax after a heartbeat. The force caused by a hit can make the ventricles contract when they are resting and result in an abnormal heart rhythm.

What are the risk factors for commotio cordis?

The following are the risk factors for commotio cordis:

  • Any blunt injury to the chest caused by any sport
  • Children younger than 20 years
  • Male sex (Boys are at a higher risk than girls.)

What are the complications of commotio cordis?

Complications of commotio cordis include the following:

  • Commotio cordis can cause arrhythmia (abnormal heart rhythms). People who continue to have arrhythmias are advised against sports or activities that have a high risk of causing chest injuries.
  • Cardiac arrest caused by commotio cordis can be life-threatening. According to National Commotio Cordis Registry, since 1996, more than 220 sudden deaths have been caused by this condition.


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How is commotio cordis diagnosed?

Commotio cordis is usually diagnosed by symptoms such as a collapse due to a hit on the chest while playing certain sports.

After administering CPR and defibrillation, the following tests are performed in the hospital:

How is commotio cordis treated?

A quick medical intervention can save a person’s life. Immediately administer CPR to a person with commotio cordis and provide medical assistance and emergency care.

Once emergency care is provided, assess the person for any other underlying heart issues and monitor them properly for the next 24 to 48 hours.

Special procedures such as therapeutic hypothermia are recommended in adult individuals who cannot follow commands. Therapeutic hypothermia helps the brain use oxygen slowly and prevent swelling in the brain.

What is the first aid for commotio cordis?

Commotio cordis is a medical emergency in which you need to act immediately before reaching medical assistance.

First aid methods that are followed include:

  • CPR: In a person with commotio cordis, immediate CPR and rapid defibrillation increase the chance of survival. The 2010 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommends early CPR and emphasizes chest compression immediately after an emergency has been activated, and the guidelines deemphasize the importance of rescue breaths and pulse checks.
  • Electrical defibrillation: Experimental studies on commotio cordis models report that defibrillation within one minute of ventricular fibrillation onset results in 100 percent survival, and defibrillation after two minutes results in 80 percent survival. Every one-minute delay in defibrillation after the first 3 minutes reduces the survival rate by approximately 10 percent. As the medical or paramedical technicians cannot arrive at the spot of emergency in less than five minutes, automated external defibrillators (AEDs) help many people in an emergency and increase their survival rate.
  • Precordial thump: During CPR, the precordial thump is considered controversial. No proven studies report the efficacy of precordial thump in resuscitation. According to AHA Guidelines, if an immediate AED or defibrillator is not available in adults, one precordial thump can be considered first aid. A precordial thump is not at all an option in children.

How to prevent commotio cordis

Commotio cordis can be prevented by taking a few preventive measures, such as:

  • An athletic trainer should be present while playing any sports or activities that can cause chest injuries.
  • The coaches should have knowledge about CPR and the use of external defibrillators.
  • Coaches, trainers, parents, and athletes must be educated about the symptoms of commotio cordis and made aware of how important and quickly CPR should be done.
  • Using pads and protective gear may help from such injuries.
  • Baseball and hockey pucks that are cushioned must be used.

Can you survive commotio cordis?

  • Immediate medical intervention and prompt treatment improve the chances of survival by 59 percent.
  • People who do not receive CPR and have congenital heart defects have fewer chances of surviving.
Medically Reviewed on 2/13/2023