The Spectrum of Findings in Cases of Sudden Death Due to Blunt Cardiac Trauma—‘Commotio Cordis’

Abstract

Commotio cordis is a term used for cases of sudden cardiac death due to nonpenetrating chest trauma without evidence of underlying myocardial disease or injury. Contusio cordis has been reserved for cases of chest trauma where there is cardiac bruising. Three deaths due to blunt cardiac and chest trauma after vehicle accidents are presented where the only significant injuries were contusions of the heart and fractures of the sternum and ribs. One case had moderate coronary artery atherosclerosis and another had a blood alcohol level of 0.218%. Given that individuals with cardiac bruising, chest trauma, coronary atherosclerosis, and alcohol intoxication may still die of the same mechanisms as in classic commotio cordis, and that these entities represent a spectrum of findings after chest impact, it may be more useful to separate cases into related subcategories: (A) those with no evidence of injury or underlying cardiovascular disease, (B) those with chest wall fractures, chest wall contusions and/or cardiac contusions, and (C) those with underlying cardiovascular disease or the presence of substances such as alcohol or drugs that may reduce the threshold for cardiac arrhythmias. As there may be cases with a number of these factors, a fourth category (D) includes those with a combination of injuries and predisposing factors (ie, categories B and C). Including cases such as these under the diagnostic umbrella of commotio cordis may demonstrate that a wider range of individuals are at risk for death from blunt cardiac trauma than sports-playing adolescents.

Sudden adult death

“…Although the intention is not to include traumatic causes of sudden death, commotio cordis (sudden death following blunt trauma to the chest) is worthy of mention as the history may not be forthcoming without consideration and direct questioning [240][241][242][243][244].…”

Death Due to Coronary Artery Insufficiency Following Blunt Trauma to the Chest

“…A focal area of atherosclerosis was found in the left anterior descending coronary artery causing 50% stenosis. In author's view, underlying cardiac disease in that case was not sufficient to cause death alone and might therefore would have predisposed to death from commotio/contusio cordis (20).…”

Cardiac injuries in car occupants in fatal motor vehicle collisions – An autopsy-based study

“…27 It has been recently suggested that the separation of blunt impact without demonstrable injury to the heart, so-called "commotio cordis", from those cases where there is bruising or associated injury is a somewhat artificial classification, as cases are in practice all part of an overlapping spectrum of merging injuries. 17 The diagnosis of coronary artery rupture can be made by Doppler echocardiography, 21 and pericardial tamponade and cardiac lacerations can be diagnosed by transthoracic or transoesophageal echocardiography. In severe blunt chest trauma, emergency thoracotomy permits rapid diagnosis and immediate surgical repair of cardiac injuries and has been shown to improve the prognosis even in patients with massive cardiac injuries.…”