Commotion in the Heart

On a warm spring night, a twelve-year-old pitcher toes the rubber in a Little League baseball game. His team is playing their in-town rivals in an intense game with many friends and family looking on. The batter, one of the best and biggest on the opposing team, awaits the pitch. The count is two balls, one strike; a hitter’s count. The pitcher winds and delivers a fastball down the middle of the plate. There is a loud “ping” followed by a dull thud. The baseball was rocketed by the trampoline effect of the batter’s aluminum bat and it struck the pitcher in the left side of the chest.  Coaches and parents rush to the mound. The pitcher, gets up, dusts himself off, proclaiming he is fine. The adults leave for the sidelines. As the pitcher returns to the rubber, he collapses, in full cardiac arrest.

What happened to this young pitcher?  He is a victim of commotio cordis, “commotion in the heart”. Commotio cordis was first described in 1857 and is defined as a blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. Commotio cordis is the second leading cause of sudden death in young athletes. Sudden cardiac arrest can occur in young athletes if a projectile, such as a baseball, strikes the chest at just the right time in the heart cycle. The projectile’s energy is transmitted to the heart, disrupting the normal heart rhythm, causing sudden cardiac arrest and collapse of the athlete. The vulnerable period for a projectile striking the heart is only about 10 to 15 milliseconds long and represents one percent of the total heart cycle. Children and young adolescents are at greatest risk for commotio cordis because they have compliant chest walls that transmit the energy of the projectile to the heart.  Commotio cordis most commonly occurs in youth baseball, but it can also happen in lacrosse, hockey, football and soccer. It can also happen during boxing or karate after a blow to the chest or after a collision between sports participants.

The treatment for commotio cordis is prompt defibrillation, an electric shock to the heart that restores the heart to normal rhythm. The shock is usually provided by an Automatic External Defibrillator (AED), a small portable device that is brought to the victim’s side. Unless the arrhythmia is treated promptly, commotio cordis is almost always fatal.  The sooner the patient is shocked, the greater the chance of surviving. Fifty percent of victims of sudden cardiac arrest survive if shocked within two to three minutes, but only ten percent will live if the shock is more than ten minutes from the time of collapse.  Timing is everything and having an AED as close as possible to potential victims can be life saving.

In recent years AEDs have become widespread.  AEDs have been used by bystanders to treat sudden cardiac arrest in airports, schools, casinos, stadiums, businesses, fitness centers and many other venues where there are large public gatherings.  With the recognition of sudden cardiac arrest in young athletes and after cases of commotio cordis have been reported, AEDs are now being placed in youth sporting facilities.  Community organizations and businesses are encouraged to buy an AED for the area’s sports venues.  An AED is not very expensive, typically costing about $1000, and the cost is equal to buying an outfield sign for three to five years.