What is commotio cordis?

Commotio cordis is an extremely rare condition that can occur when a hard object (such as a baseball or lacrosse ball) hits the chest directly over the heart at a specific time, disrupting the normal heart rhythm and leading to sudden cardiac arrest. Early treatment by CPR and an AED is critical for survival.

What causes commotio cordis?

Commotio cordis is most often seen in projectile sports (those that involve throwing objects), such as hockey or baseball. People who experience commotio cordis are usually males under the age of 20.

Commotio cordis is rare because it involves a hard object, thrown at a high speed, hitting the left side of the chest directly over the heart at the exact moment when the lower chambers of the heart are relaxing after a heartbeat. The impact can make the ventricles contract when they should be resting. This causes a ventricular fibrillation (deadly irregular heart rhythm) and sudden cardiac arrest.

Commotio cordis is rarely caused by softer or larger objects, such as tennis balls, soccer balls or footballs.

Signs and symptoms of commotio cordis

Symptoms of commotio cordis may include:

• Immediate collapse after impact
• Sudden cardiac arrest
• Unconsciousness

Diagnosis and treatment of commotio cordis

A child or teen experiencing sudden cardiac arrest needs emergency medical treatment with CPR and an AED. There are no definitive tests to confirm commotio cordis, but your child should undergo a full cardiac evaluation to rule out any underlying heart issues. This evaluation may include an electrocardiogram, heart MRI, stress test or even cardiac catheterization.

Outlook and follow-up care for commotio cordis

If a comprehensive evaluation does not uncover an underlying heart condition, no further treatment is needed for commotio cordis. Your child’s cardiologist may recommend that your child avoid sports where impact to the chest is likely, as there is a risk that commotio cordis will reoccur. Additional care will be needed if a congenital or acquired heart disease is identified.