Commotio cordis

This article has multiple issues. Please help improve it or discuss these issues on the talk page. (Learn how and when to remove these messages) This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources in this section. Unsourced material may be challenged and removed. Find sources: "Commotio cordis" – news · newspapers · books · scholar · JSTOR (January 2023) (Learn how and when to remove this message) The examples and perspective in this article may not represent a worldwide view of the subject. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. (July 2024) (Learn how and when to remove this message) (Learn how and when to remove this message)

Commotio cordis
Human adult thorax, showing the outline of the heart in red. The sensitive zone for mechanical induction of heart rhythm lies between the second and the fourth ribs, to the left of the sternum.
Specialty	Cardiology, emergency medicine, sports medicine
Complications	Ventricular fibrillation, quickly followed by cardiac arrest and (if not treated) death
Usual onset	Within seconds after impact
Causes	Sufficient blow to the precordium between 10 and 40 milliseconds before the peak of the T wave portion of normal cardiac rhythm
Risk factors	Coronary ischemia can reduce amount of impact energy required to trigger
Treatment	CPR, defibrillation
Prognosis	Survival rate drops to <5% if not resuscitated within 3 minutes
Frequency	Extremely rare

Commotio cordis (Latin, "agitation / disruption of the heart") is a disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart (the precordial region) at a critical instant during the cycle of a heartbeat.^[1] The resulting sudden rise in intracavitary pressure leads to disruption of normal heart electrical activity, followed instantly by ventricular fibrillation, complete disorganization of the heart's pumping function, and cardiac arrest. It is not caused by mechanical damage to the heart muscle or surrounding organs and is not the result of heart disease.

The incidence of commotio cordis in the United States is fewer than 20 cases per year. It often occurrs in boys participating in sports, most commonly in baseball when a ball strikes a player in the chest. Its rareness arises because it can occur only upon impact within a window of about 40 milliseconds in the cardiac electrical cycle.^[1]

The condition has a 97% fatality rate if not treated within three minutes.^[2] If cardiopulmonary resuscitation (CPR) combined with the use of an automated external defibrillator is employed within three minutes of the impact, survival can be as high as 58 percent.^[3]