Commotio cordis is an often-fatal injury that occurs when you’re hit in the chest and that impact triggers a dramatic change in the rhythm of your heart. The blow could come from an object, like a baseball or hockey puck, and may not seem especially serious in the moment.

Commotio cordis most commonly affects male teen athletes. Without immediate treatment, this condition can cause unexpected cardiac death.

Immediate first aid treatment with cardiopulmonary resuscitation (CPR) and heart defibrillation with an automated external defibrillator (AED) may be able to restore the heart’s healthy rhythm and save a life.

After being hit in the chest, a person with commotio cordis may stumble forward and lose consciousness. The injury won’t show any outward trauma to the chest. There may not be a bruise or any indication of a serious blow.

You may not be able to detect a pulse following the injury. The individual hit in the chest will have stopped breathing.

Just getting hit in the chest isn’t enough to cause commotio cordis. The timing of the blow must be at a precise moment during a heartbeat and strike an area near the center of the heart’s left ventricle. The left ventricle is the lower left chamber of the heart.

This can trigger ventricular tachycardia. Ventricular tachycardia refers to a fast, irregular beating of the heart in the lower chambers. This is a serious condition. The same type of contact to the chest a moment later or an inch to one side may be nothing but harmless contact.

Some of the main causes of commotio cordis include being hit by a:

  • baseball
  • lacrosse ball
  • hockey puck
  • hockey stick

Playing any sport where you’re at risk for blunt trauma to the chest increases your chances of commotio cordis. Some of the sports that are most likely to result in commotio cordis include:

  • baseball
  • softball
  • lacrosse
  • cricket
  • hockey

People who engage in full-contact martial arts are also at higher risk.

Diagnosed cases of commotio cordis are unusual. There are only about 10 to 20 events each year in the United States. More cases may occur annually, but aren’t reported as commotio cordis due to poor public understanding of the condition. This condition is most commonly seen in males between the ages of 8 and 18.

If you suspect commotio cordis, fast treatment is essential. For every minute that passes after losing consciousness, the survival rate drops by 10 percent. To treat:

  • Perform CPR right away.
  • Proper use of an AED may also help restore the heart to a healthy rhythm.
  • Have someone not performing CPR call an ambulance. If no one else is available to call an ambulance, call your local emergency services while performing CPR, or continue CPR until you’re able to signal for someone to help.

CPR and AED use should continue until an ambulance arrives, unless the person has regained consciousness and appears to be stable.

A person with commotio cordis who survives should be hospitalized and observed for a few days, depending on their recovery and overall health. Anti-arrhythmic medications may be administered to help keep the heart in a steady, healthy rhythm.

If the heart is beating normally and there are no other health problems, the person may be released to resume normal activities. Follow-up appointments with a cardiologist may be recommended for periodic checks on the heart’s rhythm and function.

Successful treatment and recovery from commotio cordis may result in no further heart problems. You may, however, need an electrocardiogram to check your heart for any rhythm disturbances and a doctor’s approval before you’re cleared to play sports again.

Continued abnormal heart rhythms (arrhythmias) may require medication and possibly a pacemaker. You may be advised against contact sports or activities in which chest trauma is possible.

Arrhythmias are usually the result of heart conditions, such as:

While it may be impossible to prevent injuries to the chest in sports or in other circumstances, such as car accidents, there are steps that can be taken to reduce complications from commotio cordis, including loss of life.

Among the important steps youth teams or leagues can take to combat commotio cordis include:

  • have an athletic trainer present at practices and games
  • make sure an AED is available at all athletic facilities, and that coaches and others involved know how to access it easily
  • educate trainers, coaches, parents, and athletes about how to recognize commotio cordis symptoms, perform CPR, and use an AED

Efforts to reduce the likelihood of the chest injury itself include:

  • making sure pads and other protective equipment are worn properly and consistently
  • teaching athletes how to avoid being hit with a ball, puck, or other implement that could cause this injury
  • avoiding strength and weight disparities between athletes whenever possible
  • using safety baseballs and hockey pucks

Commotio cordis is a dangerous condition. If you have a child playing a sport in which a chest injury is possible, make sure available protective equipment is worn and that the school or league involved has an AED and trained users available at all times.

Fast intervention can save the life of someone experiencing commotio cordis.