What Is Commotio Cordis?

Medically Reviewed by James Beckerman, MD, FACC on January 03, 2023
5 min read

Commotio cordis is a medical condition that happens when your heart suddenly stops beating (known as cardiac arrest). It usually happens when there's a serious blow or injury to the chest that causes abnormal electrical activity in the heart.

The condition is rare. It's most commonly seen among athletes ages 8-18 who play contact sports like football or martial arts. It can also happen in sports that involve blunt objects like baseballs, hockey pucks, or lacrosse balls.

Commotio cordis is an extremely dangerous condition and can lead to death. It's the second leading cause of sudden cardiac death among athletes. If it occurs, CPR and medical attention are needed right away to restore the heartbeat as soon as possible or the odds of survival are very low.

The most common cause is an impact to the left side of your chest during a sports activity. The impact gives a sudden jolt to the heart muscle. This can cause the heart to have a sudden, irregular, and fast pattern of heartbeats (ventricular fibrillation) and effectively stop beating.

Boys are more likely than girls or adults to experience commotio cordis. In fact, over 9 out of 10 reported cases occur in boys.

Experts believe that a thinner chest wall among young children compared to adults increases the odds of commotio cordis.

Younger people are also more likely to play sports that involve contact and collisions, which could result in a chest injury like this.

The timing of the impact or blow to the chest during a heartbeat cycle also matters for commotio cordis. During each heartbeat, there is a brief period of time in which the heart's electrical system is more vulnerable. A sudden impact can increase the likelihood of a dangerous heart rhythm like ventricular fibrillation.

Symptoms can include:

  • A sudden collapse, with stumbling for a few seconds beforehand
  • Unresponsiveness
  • Not breathing
  • No pulse
  • No heartbeat
  • Bluish or purple skin (cyanosis) due to a lack of oxygen
  • Seizures
  • Bruising or injury to the chest

Commotio cordis is a medical emergency. You'll need to act immediately to resuscitate the person while you wait for professional medical attention. The first thing to do if someone is unresponsive is to start chest compressions while someone else calls 911 and locates an AED (automated external defibrillator). This is a medical device that sends electric shocks to the heart and restores the heartbeat (defibrillates).

You'll need to do this as soon as a person collapses suddenly and has no sign of a heartbeat. For every minute of delay in getting defibrillated, the odds of survival go down by 10%.

To increase chances of survival, you'll need to perform CPR chest compressions immediately after a shock from the AED as you prep the AED to deliver another round of shocks. Do this for 2 minutes before you stop to check for a pulse or a heartbeat.

In the meantime, call 911. Continue to perform the combination of AED and CPR until help arrives. Research shows that if you try to resuscitate a person with commotio cordis within 1-3 minutes of the incident, their odds of living are greater.

You can use AEDs on children older than 1 year.

Once you get to the hospital, you'll likely be admitted for advanced medical care and observation. You might need to stay in the hospital for a long time.

You'll get medications to treat the irregular heartbeat. Your doctor may run tests like an electrocardiogram (EKG) and do thorough physical exams to rule out any underlying causes or medical conditions.

It's possible to confuse commotio cordis with other similar medical conditions like myocardial contusion (or commotio contusion).

When you have commotio cordis, you're less likely to have any structural damage to the heart, but the sudden blow might make your heart stop beating.

With myocardial contusion, the heart muscle might be damaged, bruised, torn, or ruptured. There might be damage to the heart valves or different chambers of the heart. This is usually caused by blunt trauma to the heart or chest cavity during a car crash or fall.

This can cause irregular heartbeats. For some, if myocardial contusion is minor, there may be no symptoms. Recovery will depend on how severe your injuries are.

Other conditions that commotio cordis could look like include:

The outlook for commotio cordis, especially if you don't get immediate and rapid medical attention, isn't good. According to research, about 6 out of 10 people survive after commotio cordis.

Research also shows that Black people have lower rates of survival compared to white people with this condition.

Your odds of surviving are lower if it happens at home or during a recreational sporting event rather than an organized competitive sporting event. The difference lies in how soon you get medical attention after you have symptoms of commotio cordis.

To prevent commotio cordis and to improve chances of survival, you can:

  • Learn how to recognize the symptoms of commotio cordis. This will help you provide rapid medical attention.
  • Make sure there are AEDs available and handy at every sporting event.
  • Make sure there's an athletic trainer present at all games and practice sessions.
  • Make sure everyone who uses athletic facilities -- coaches, staff, parents, and all athletes -- knows how to perform CPR and use an AED.
  • Have an emergency action plan (EAP) in place. This includes knowing where the AED is located and how to use it. Also, establish a chain of command and elect somebody to be in charge to call the shots in case of a medical emergency.
  • Always wear protective gear and equipment that fits you properly when playing sports.
  • Require that children age 13 or younger use safety baseballs.
  • Learn safe playing techniques to avoid getting hit or badly hurt during play.