Commotio Cordis: Everything You Should Know

Medically Reviewed by Jabeen Begum, MD on April 03, 2024
8 min read

Commotio cordis is a medical condition that happens when your heart suddenly stops beating (known as cardiac arrest). It usually happens due to 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 aged 11-20 who play contact sports such as football or martial arts. The average age of those who have commotio cordis is 15. It can also happen in sports that involve blunt objects such as baseballs, softballs, 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, cardiopulmonary resuscitation (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 of commotio cordis 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 result in a sudden, irregular, and fast pattern of heartbeats (ventricular fibrillation), which causes the heart to effectively stop beating.

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

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

Younger people also are 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 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 of commotio cordis 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

A doctor might suspect commotio cordis if you collapse after receiving a hit to the left side of your chest while playing a sport. The first priority is to restart your heart and stabilize you. Later, at the hospital, doctors will try to confirm the diagnosis. Tests you might have include:

Electrocardiogram (EKG). For this test, electrodes are placed on your chest and limbs. They monitor your heart's electrical activity and create a computer printout your doctor can study. This is a noninvasive test.

Echocardiogram. This test uses ultrasound to make images of your heart's structures, such as chambers and valves. This helps doctors see how well your heart is pumping. The technician who does the test will place a handheld wand against your chest.

Blood tests. A variety of blood tests can be used to check for cardiac problems. In addition to measuring things such as your cholesterol level, the tests can check for proteins that signal inflammation or affect your blood's clotting ability and an amino acid that increases your risk of heart failure.

Heart MRI or CT scan. A cardiac MRI uses radio waves and magnets to create images of your heart's structures. A cardiac CT scan produces three-dimensional images of your heart's structures. The imaging machine moves around you, creating multiple X-rays.

Heart catheterization. This is an invasive procedure, but the risk is very low. A thin, flexible tube (catheter) goes into a blood vessel in your groin or arm and then moves up into the arteries that supply your heart. A small camera gives the doctor an image of your arteries. Some problems can be repaired during catheterization.

You also might have regular X-rays if your doctor suspects the blow to your chest broke a bone. Your doctor also might order a stress test, which involves an EKG taken while you walk on a treadmill or pedal an exercise bike.

Commotio cordis is a life-threatening emergency. You'll need to act immediately to resuscitate the person while you wait for professional medical attention.

How to perform CPR

According to the American Red Cross, these are the seven steps of CPR:

  1. Make sure the area is safe and do a quick assessment of the person in crisis.

  2. If the person seems unresponsive, check for responsiveness and breathing. Look for any bleeding or other injuries.

  3. If the person doesn't respond, isn't breathing, or is gasping, call 911. Ask someone nearby to locate an automated external defibrillator. These devices can be found in many public buildings. They are meant to be used by people without medical training. They analyze the heart's rhythm, and if it's needed, provide an electrical shock to the heart.

  4. Place the person on their back on a firm, flat surface. Kneel beside them.

  5. Give 30 chest compressions. Center both hands on the person's chest. Your shoulders should be above your hands. Lock your elbows. The compressions should be at least 2 inches deep. Allow the chest to go back to its normal position between compressions. The rate of compressions should be 100-120 per minute.

  6. Give two breaths. Tilt the person's head or lift their chin to open their airway. Pinch their nose closed, take a normal breath, then cover the other person's mouth completely with your own. Each breath should last about 1 second, and their chest should rise with each breath. If the first breath doesn't cause the chest to rise, double-check to make sure their airway is clear.

  7. Continue to give 30 chest compressions followed by two breaths until someone arrives with an automated external defibrillator (AED).

You should continue to use AED and perform 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 probably be admitted for advanced medical care and observation. You might need to stay in the hospital for a long time.

You might get medications to treat the irregular heartbeat. Your doctor will attempt to confirm the commotio cordis diagnosis with tests. You'll also have a thorough physical exam to rule out any underlying causes or medical conditions.

It's possible to confuse commotio cordis with other similar medical conditions such as 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 than 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 your chances of survival, you can:

  • Learn how to recognize the symptoms of commotio cordis. This will help you get 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 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 aged 13 or younger use safety baseballs.
  • Learn safe playing techniques to avoid getting hit or badly hurt during play.

Commotio cordis is a life-threatening medical emergency that causes your heart to stop beating. It's usually the result of a blow to the chest, often during sports such as football or martial arts. It also can happen if you're hit hard in the chest by something like a baseball, softball, hockey puck, or lacrosse ball. If you think someone has commotio cordis, a quick response can be the difference between life and death. Call 911, send someone to locate an AED (a type of defibrillator), and begin CPR. If you have commotio cordis, once you're stabilized, doctors will try to confirm what made your heart stop.

What's the survival rate for commotio cordis?

Commotio cordis is one of the main causes of sudden cardiac death in young people who play sports. About 59% of people who experience it survive. You're most likely to survive if you receive CPR right away.

Can a punch cause commotio cordis?

Yes, it's possible for a punch to cause commotio cordis, but the circumstances would have to be just right. It would have to hit your chest at a certain angle and a speed of 40 miles per hour or more. The punch also would have to land during a specific part of your heart's cycle when the electrial system is vulnerable to disruption.