A Lethal Blow to the Chest as an Underdiagnosed Cause of Sudden Death in United Kingdom Sports (Football, Cricket, Rugby)

Cooper, Susanna T E; Woodford, Noel; Maron, Barry J.; Harris, Kevin M.; Sheppard, Mary N.

doi:10.1016/j.amjcard.2019.05.050

Cited by 16 publications

(13 citation statements)

References 16 publications

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“…The Latin translation means "agitation of the heart," and it appears to be a primary arrhythmic event initiated by mechanical stimulation that predominantly affects young males and frequently in association with sports practice. 1 Our patient was older, and the CC was secondary to aggression. With low recognition, atypical cases, such as those secondary to aggression, are even more challenging to recognize.…”

Section: Discussionmentioning

confidence: 72%

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Commotio Cordis Secondary to Aggression

Gonçalves¹,

Pires²,

Santos³

et al. 2021

International Journal of Cardiovascular Sciences

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A 35-year-old man was admitted following a recovered cardiorespiratory arrest. He was attacked by another man with multiples blunts by a wood stick in the chest and head. An eyewitness statement indicated that the victim had lost consciousness and collapsed after being hit in the chest. He was in cardiac arrest, and a nearby healthcare professional provided first aid with cardiopulmonary resuscitation. The first electrocardiogram (ECG) rhythm strip, fifteen minutes later, identified ventricular fibrillation (VF) (Figure 1A). Sixteen electrical shocks were delivered, always with VF, before restoration of sinus rhythm and circulation. A 12-lead-ECG revealed sinus rhythm without ST deviations and a corrected QT interval of 414 msec. On admission, he was under ventilatory support, with a heart rate of 80 beats per minute, blood pressure of 121/70mmHg, and no signs of shock. There was no previously known medical condition, besides being an active smoker and a binge drinker, and no family history of early coronary disease, cardiomyopathy, or sudden death. He was under the influence of alcohol, as was confirmed by blood tests (blood alcohol level of 1.31g/L), and had a discretely elevated cardiac troponin-T of 0.9ng/ml (normal range, 0 to 0.08 ng/ml). The remaining analyzes, cranial and cervical CT scan, chest X-ray, and abdominal eco FAST were normal. An initial echocardiogram in the emergency department demonstrated normal-sized chambers and global ventricular systolic dysfunction

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Section: Discussionmentioning

confidence: 72%

“…8 Resuscitation is often unsuccessful, and early defibrillation is critical. 1,8 Our patient was lucky to be treated immediately and continuously by a nearby health professional until defibrillation was possible. Although the initial refractory VF, he recovered without sequelae.…”

Section: Discussionmentioning

confidence: 99%

Commotio Cordis Secondary to Aggression

Gonçalves¹,

Pires²,

Santos³

et al. 2021

International Journal of Cardiovascular Sciences

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“…an electrically vulnerable period of cardiac repolarization, this depolarization can induce a sustained ventricular arrhythmia, often difficult to control and recurrent. 13 The phenomenon can be immediate with a rapid and complete loss of consciousness, although ∼20% of patients are able to continue their activity for a few seconds 13 , 14 (cf. Case 2).…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of commotio cordis appears to be higher in the USA than in Europe (21.6× higher) due to the more common practice of competitive contact sports among North American youth and also to the absence of a dedicated registry in Europe. 14 , 16 A recent review of the literature found only 215 reported cases (160 autopsies performed) of commotio cordis with an estimated incidence of 3–6% of SCD occurring during sporting activity. 17 , 18 However, underreporting is a possibility, considering the poor survival rates, the circumstances of occurrence, and the definitions used.…”

Section: Discussionmentioning

confidence: 99%

Sudden cardiac death risk in contact sports increased by myocarditis: a case series

Massoullié

Boyer

Sapin

et al. 2021

European Heart Journal - Case Reports

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Background Myocarditis is a known cause of sudden cardiac death of the athlete. The impact of direct chest trauma in at-risk sports or activities in patients with a history of myocarditis has never been demonstrated or studied. We report herein two cases of life-threatening ventricular arrhythmia secondary to non-penetrating blunt chest trauma while playing contact sports. Case summary The first patient, a 26-year-old man described a brief loss of consciousness after having received blunt impact to the chest (typical intensity) while playing a rugby match. The loss of consciousness was total and proceeded by rapid and regular palpitations. He had a history of viral myocarditis 10 years prior with a fibrotic sequalae in the inferolateral wall on cardiac magnetic resonance imaging (left ventricular ejection fraction 71%). Right apical ventricular pacing induced a sustained monomorphic ventricular tachycardia reproducing the patient’s symptoms. A subcutaneous implantable cardioverter-defibrillator was implanted. The second patient is a 22-year-old professional rugby player with no known notable history. During a match, a direct blow to the chest wall was followed by a cardiac arrest. A ventricular fibrillation was cardioverted to pulseless electrical activity. Patient died despite cardiopulmonary resuscitation. An autopsy identified a myocardial sequela of fibrosis with no acute inflammatory remodelling compatible with a previous myocarditis. Discussion Myocarditis may increase the risk of life-threatening ventricular arrhythmias caused by blunt impact to the chest, particularly in contact sports. Screening and prevention measures should be considered to reduce this risk.

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“…21 While the majority of contact-induced thoracic injury involves superficial musculoskeletal structures, the evaluating physician should also be aware of rare, yet potentially lethal internal organ injuries, including commotio cordis and pulmonary injuries. 22 As a superficial structure in the anterior thorax, the sternum is susceptible to injury during rugby play.…”

Section: Thoracic Injuriesmentioning

confidence: 99%

Injury Patterns in Rugby Union—America’s Fastest Growing Sport

Farah¹,

Mitchell²,

Schmitz³

et al. 2022

Journal of the Pediatric Orthopaedic Society of North America

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Rugby union is the fastest growing sport in the USA, and its growth is only expected to continue to climb with the approaching 2023 Rugby World Cup. Rugby union carries risk for general and sport-specific injury. Tackles and high-impact collisions are a regular component of the game, and although often compared to American football, rugby union carries a unique pattern of injuries, with certain injuries occurring at a significantly higher rate. This review is aimed at familiarizing our orthopaedic workforce to the sport of rugby union and the evaluation, diagnosis, and treatment of the rugby union athlete. Injury prevention strategies guided by epidemiology, risk factors, and mechanisms of injury in rugby union athletes are critical.

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A Lethal Blow to the Chest as an Underdiagnosed Cause of Sudden Death in United Kingdom Sports (Football, Cricket, Rugby)

Cited by 16 publications

References 16 publications

Commotio Cordis Secondary to Aggression

Commotio Cordis Secondary to Aggression

Sudden cardiac death risk in contact sports increased by myocarditis: a case series

Injury Patterns in Rugby Union—America’s Fastest Growing Sport

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