Medically Reviewed by Charlotte E. Grayson Mathis, MD From the WebMD Archives
Nov. 12, 2001 — Every now and then, we hear of a perfectly healthy child or teen dying after being struck soundly in the chest with a hockey puck, baseball, or some other, usually sports-related, projectile. Now, researchers taking a closer look at the phenomenon have discovered that far more innocent strikes to the chest of a child — to relieve the hiccups, for instance, or with a hollow plastic bat — can also cause sudden death.
Lead researcher Barry J. Maron, MD, with the Minneapolis Heart Institution Foundation, presented his team’s findings Nov. 12 at the American Heart Association’s Scientific Session 2001 conference.
They investigated the 106 deadly and 18 near-deadly cases of commotio cordis, or blunt chest blows, registered in the U.S. through 2001. Victims ranged in age from 1 to 44 years, but 43% of them were younger than 12, only 22% were over 18, and most (95%) were male.
“These fatal chest blows often occurred inadvertently in young children and under bizarre circumstances not usually associated with sudden death risk, that is, from projectiles such as … a snowball, the head of a pet dog, a plastic sledding saucer, as well as from bodily contact during play “shadow” boxing, parent-child discipline, or in the course of terminating a scuffle,” the researchers write.
Commotio cordis is a medical term that means “concussion of the heart.” Because the syndrome is almost always fatal and appears to occur in otherwise healthy people, especially children, it has gained wide attention over the past decade. Doctors believe that commotio cordis occurs when a chest blow disrupts the normal electrical activity of the heart. Depending on timing, the chest blow could cause fainting but not death, or it could cause the heart to cease pumping, leading quickly to death.
According to the researchers, the most vulnerable children are boys younger than 12 with a narrow rib cage and underdeveloped chest muscles. The phenomenon is indeed rare, but all children are potentially at risk.
Any blow to the chest can produce cardiac arrest, even one that seems quite harmless, says Maron. The most effective way to get a heart beating again is CPR and defibrillation (those electric shock paddles we’ve all seen on TV). But time is of the essence. For every minute lost, the chance of survival is reduced about 10%, and resuscitation attempts are rarely successful after 10 minutes.
Parents would be advised to caution their children about the danger of striking others, or allowing others to strike them, in the chest, even in fun. “Striking the chest at any time is not advisable under any circumstances, even when the blow is trivial,” says Maron in a news release. “The general public is largely unaware of the fact that striking the chest, even lightly, can sometimes result in death.”
