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Protecting Young Athletes' Hearts

Gear May Not Protect Kids From Balls That Strike the Chest
WebMD Health News
Reviewed by Louise Chang, MD

Nov. 15, 2006 (Chicago) -- Despite wearing the latest chest gear, young athletes can still die if a ball or puck hits them in the chest in the right spot at the right time, researchers report.

"An unlikely conspiracy of a number of variables can conspire to cause sudden death from a hit in the chest," says Barry J. Maron, MD, director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute.

Maron established the first national registry to track the condition, known as commotio cordis, in 1995. Since then, he has recorded 85 cases in which young athletes were killed by a chest blow during organized sporting events. In 33 cases, the child was wearing protective gear.

Those numbers underestimate the scope of the problem, he tells WebMD. "We could only collect data on what we knew about -- if the death was published in a newspaper and could be found using a search engine, for example. Or if we heard about it by word of mouth."

Speaking here at the annual meeting of the American Heart Association (AHA), Maron says that fatal blows are most common among children aged 13 to 15 who are playing baseball, softball, or hockey.

Before collapsing and dying, "these were healthy kids with no genetic predisposition to early heart problems," he says.

Conspiracy of Timing and Location

He blames the deaths on an unlucky alliance of the location and timing of the hit. "The blow has to be directly to the heart -- that is, the left chest area. And it has to be timed exquisitely to a vulnerable period of the heart cycle when there is electrical relaxation of the lower chambers, a period that lasts only 20 milliseconds," Maron says.

The result is ventricular fibrillation, when the heart's electrical activity goes out of whack. The electrical storm makes the heart quiver, and little or no blood is pumped out to the rest of the body. The child collapses and dies if a defibrillator is not immediately used to shock the heart back to normal.

Maron adds that the velocity of the ball or puck when it hits the chest doesn't appear to matter. "Some were very innocent blows," he says.

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