Athletes can suffer heart concussion

It does not happen often but a few times a year, the media reports about very young athletes suddenly suffering heart failure. When this happens it is almost always in connection with contact sports. It is a kind of “concussion” - only it is of the heart.

The condition is called commotio cordis (“heart concussion”). It occurs after a blow to the chest, and if specific conditions exist, the serious cardiac arrhythmia (ventricular fibrillation) will result in death. The blow must be to one specific, small spot on the chest and with a certain velocity of impact, and not least, the impact must occur within a 30 millisecond proportion of the cardiac cycle. If all these conditions are present at one rare occasion at the same time, this may result in commotio cordis which has a very high mortality.

According to the weekly journal of the Danish Medical Association, an account of the first 128 incidences in the American register from 2002, shows that commotio cordis occurs most often to young athletes. In 62 percent of the incidences these were persons participating in sports with bodily contact, both at professional level and as amateurs. Among young athletes, commotio cordis is the second most common cause of death. The remaining 38 percent of incidences of commotio cordis were registered in younger persons and occurred most often in connection with apparently peaceful leisure activities. The majority of incidences appeared not to involve a particularly violent or intentional impact or blow to the chest.

The average age for young athletes who experienced this condition was 13 years-old, and in extremely rare cases more than 18 years-old. In 95 percent of American incidences in boys, i.e. 107 of the 128 incidences, the blow and the subsequent heart concussion were fatal.

According to Danish physicians from Rigshospitalet and Frederiksberg Hospital, who have analysed and published an article based on the American survey, increasing awareness about this sudden death in young athletes in general and commotio cordis specifically, will help reduce mortality. This may be through education and training so that first aid can be provided faster in cases of heart failure, and also through targeted design of protective equipment within certain sports.
 
Contact: Steen Pehrson, Consultant Surgeon, the Heart Centre, Rigshospitalet.