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Autonomic Function Following Concussion in Youth Athletes: An Exploration of Heart Rate Variability Using 24-hour Recording Methodology
Published on: September 21, 2018
Cardiac concussion (commotio cordis)
Rahim Valani1, Angelo Mikrogianakis, Ran D Goldman
1Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Commotio cordis, or cardiac concussion, is a sudden heart rhythm disturbance caused by blunt chest trauma in children. Immediate collapse can occur, but prevention through safety gear and defibrillation is key.
Area of Science:
- Pediatric Cardiology
- Sports Medicine
- Trauma Surgery
Background:
- Blunt chest trauma can cause myocardial injuries in children.
- Commotio cordis occurs when the precordium is struck during a vulnerable cardiac cycle phase.
- Patients typically have no prior cardiac issues, and autopsies show no structural heart damage.
Purpose of the Study:
- To describe the phenomenon of commotio cordis in pediatric blunt chest trauma.
- To outline the clinical presentation and underlying mechanism.
- To emphasize preventative strategies.
Main Methods:
- Review of clinical presentations of commotio cordis.
- Analysis of the timing of precordial impact relative to the cardiac cycle.
- Discussion of autopsy findings in affected patients.
Main Results:
- Commotio cordis presents as immediate collapse due to lethal arrhythmia.
- The injury mechanism involves impact during the vulnerable repolarization period.
- No predisposing cardiac conditions or autopsy-confirmed heart damage are found.
Conclusions:
- Commotio cordis is a distinct entity in pediatric blunt chest trauma.
- Immediate collapse is the hallmark presentation.
- Prevention via safety equipment and prompt defibrillation is crucial.
Abstract:
Blunt chest trauma in pediatric patients can result in various injuries to the myocardium. Cardiac concussion (commotio cordis) is seen in patients in whom the precordium has been struck with relatively little force at a vulnerable period of the cardiac cycle. These patients have no predisposing cardiac problems, and autopsy reveals no evidence of heart damage. The usual clinical presentation is that of immediate collapse secondary to a lethal arrhythmia. Prevention is the cornerstone of potentially decreasing the incidence with the aid of safety equipment and, possibly, immediate defibrillation.
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