What is Commotio Cordis?

One of the first big headlines of 2023 was the shocking news of how 24-year-old Buffalo Bills football player, Damar Hamlin, suffered a cardiac arrest while playing in a nationally televised NFL game. Hamlin took a hit on the field, rose, took a step before falling backward and lay on the field for about 10 minutes while medical staff performed CPR. Reports arose that perhaps Hamlin's cardiac arrest was due to what is known as "commotio cordis". What is this condition? M. Kate Elfrey, D.O., a cardiologist with The Heart Center at Mercy, responded to a query from Parade magazine on the topic. The following is her response.

Commotio cordis essentially means "chaos in the heart." It is a condition mostly seen in young male athletes, with a median age of 15 to 17 years old. It can occur when there is blunt trauma to the anterior chest wall which triggers an irregular heart rhythm.

The heart routinely follows a regular electrical conduction circuit to produce each heartbeat. If this circuit is interrupted at just the right time (in this case by blunt trauma), the routine circuit degenerates into a dangerous heart rhythm called ventricular fibrillation.

Ventricular fibrillation is a lethal heart rhythm because the heart is unable to adequately fill and pump blood flow to the body, particularly the brain. This will result in sudden loss of consciousness and the loss of a pulse. Once ventricular fibrillation occurs, the heart needs to be reset as soon as possible in order to restore blood flow to the brain and body.

The common symptoms seen with commotio cordis are sudden and abrupt loss of consciousness after blunt trauma to the chest.

Those most at risk are young males between the ages of 10 and 20 because their breast bone and sternum have not completely developed. This makes the heart more susceptible to blunt trauma.

This is most often seen in sports that involve a ball or puck such as baseball, lacrosse and hockey and can occur when the ball or puck strikes the chest. Contact sports that can result in trauma to the anterior chest also raise risk.

The treatment for commotio cordis first includes quick diagnostic recognition. Any athlete that collapses after trauma to the chest should immediately be examined for a pulse. If no pulse is identified, then prompt CPR with the concomitant use of an Automatic External Defibrillator (AED) is the life-saving treatment.

The defibrillator will recognize the abnormal rhythm, ventricular fibrillation, and deliver a shock to the heart to restore it to normal.

The time that the heart is not beating properly, or is in ventricular fibrillation, is the time that the brain is not getting adequate oxygen. Therefore, prompt, recognition and treatment are essential to survival and recovery prognosis.

You might have the chance to save a life, learn CPR, and be prepared!

Dr. Elfrey is a graduate of the New York College of Osteopathic Medicine and completed her residency at Johns Hopkins Bayview Medical Center. On staff at The Heart Center at Mercy, Dr. Elfrey sees patients at Mercy Personal Physicians at Overlea, Lutherville, and in downtown Baltimore. The cardiologists of The Heart Center at Mercy specialize in the diagnosis, treatment and prevention of heart disease including coronary artery disease (CAD), heart attack and high blood pressure.