ESTES FINAL COMMOTIO STANFORD -...
Transcript of ESTES FINAL COMMOTIO STANFORD -...
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Commotio Cordis
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Case Report
14 year old healthy boy.
During football he is hit in anterior chest.
Patient immediately states that he is dizzy and
then loses consciousness.
CPR begins within 1 minute, and EMS arrives
at 6 minutes.
Link, et al, Chest, 1998
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Definitions and Background
Commotio Cordis
Concussion of the heart
Commotio cordis-disturbed or agitated heart
motion (Latin)
Chinese Martial Art Dim Mak (death touch)
precordial blow results in sudden death in
one’s opponent
Sudden death from chest wall impact
At autopsy, no pathologic abnormalities.
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Juvenile
anesthetized male
swine placed prone
in a sling.
Baseball propelled
at 30 mph.
Release of the
object was timed so
that the impact
could be adjusted
according to the
cardiac cycle.
II p a t L o c a t i o n
I n h a l e d A n e s t h e s i a
S t i m u l a t o r E l e c t r o c a r d i o g r a m
R e l e a s e
P r o j e c t i l e
S l i n g
X
Impact location
Stimulator Electrocardiogram
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T-wave Impact
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QRS Impact
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Hockey-Chris Pronger
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Lacrosse Chest Wall Protection
Maron, Link, Estes in press 2009
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Left Ventricular Pressure In
Commotio Model
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T-wave
Impact
Link,
Circulation,
1999
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Commotio AEDs
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Commotio AEDs
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Commotio Cordis Conclusions
In humans, the clinical scenario is produced by
low energy chest wall impact in an area
overlying the heart
Young males are the most susceptible to
commotio cordis
The initial rhythm, when documented, is most
often ventricular fibrillation
Survivors have had ST elevation on EKGs
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Commotio Cordis Conclusions
Low energy trauma during a 30 ms window on the
upslope of the T-wave causes ventricular fibrillation
in juvenile swine
The VF produced is immediate and not preceded by
PVC’s, ST elevations or other EKG abnormalities
The site of impact must directly overlie the cardiac
silhouette
Changes in LV pressure may mediate VF
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Commotio Cordis Conclusions
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Commotio Cordis