Hamlin shared his appreciation for the public’s support. “Watching the world come together around me on Sunday was truly an amazing feeling,” Hamlin wrote. “The same love you all have shown me is the same love that I plan to put back into the world n more. Bigger than football!” Hamlin was hurt after tackling Bengals receiver Tee Higgins on Jan. 2. While running with the ball, he hit Hamlin with his right shoulder in the chest. Hamlin stood up, but within seconds collapsed and went into sudden cardiac arrest. He received CPR and needed the assistance of a defibrillator to resuscitate him. According to the American Heart Association, more than 365,000 people in the U.S. each year have sudden cardiac arrests in non-hospital environments. Immediate CPR and getting the heart back into a normal rhythm are critical for survival, as seen in Hamlin’s case. Cardiologists continue to speculate the reasons as to why this tragedy happened and many agree that it could be a condition called commotio cordis. Here’s everything you need to know about the condition and what likely occurred on the field.
What Is Commotio Cordis?
Commotio cordis is a rare condition where the heart suddenly stops pumping due to a direct impact. The heart is in an abnormal rhythm called ventricular fibrillation, Dr. Kaustubh Dabhadkar, MD, a cardiologist with expertise in preventive cardiology, explains. As the name suggests, the heart’s bottom chambers (called ventricles) are fibrillating instead of pumping. Since an impact triggers the situation, no warning signs exist. Based on research conducted on pigs, a direct impact over the heart by a hard object moving between 40 and 60 mph at a specific point in the heart rhythm cycle triggers this condition, Dr. Dabhadkar states. It has been reported in young male athletes, mostly under 20. In Hamlin’s case, Higgins’ right shoulder directly hit Hamlin’s chest wall over the heart. Such an impact between two moving objects could create a pressure between 250 mmHg to 600 mmHg over the chest wall. Although we may never know, the impact was likely during the early part of the heart’s relaxation to prepare for the next heartbeat, Dr. Dabhadkar adds. Cleveland Clinic explains, “With commotio cordis (Latin for ‘agitation of the heart’), the impulse from the object disrupts the normal heart rhythm and leads to sudden cardiac arrest.” “In detail, the heart routinely follows a regular electrical conduction circuit to produce each heartbeat,” Dr. Kate Elfrey, DO, a cardiologist with The Heart Center at Mercy, explains. “If this circuit is interrupted at just the right time (in this case by blunt trauma), the routine circuit degenerates into a dangerous heart rhythm called ventricular fibrillation.” Ventricular fibrillation is a lethal heart rhythm because the heart is unable to adequately fill and pump blood flow to the body, particularly the brain, Dr. Elfrey states. This will result in a sudden loss of consciousness and the loss of a pulse. Once ventricular fibrillation occurs, the heart needs to be reset as soon as possible in order to restore blood flow to the brain/body.
Symptoms and Risk Factors
According to Cleveland Clinic, “Cases of commotio cordis are extremely rare. There are fewer than 30 cases each year.” Yet, they still occur, and bring about serious, life-threatening symptoms. “The common symptoms seen with commotio cordis are sudden and abrupt loss of consciousness after blunt trauma to the chest,” says Dr. Elfrey.
Cleveland Clinic lists the symptoms of commotio cordis as:
Collapse immediately after getting hit in the chest.Ventricular fibrillation.Cardiac arrest.Unconsciousness.
Those most at risk are young males between the ages of 10 to 20. This is because their breast bone and sternum have not completely developed, making the heart more susceptible to blunt trauma, Dr. Elfery explains. Commotio cordis is most often seen in sports that involve a ball or puck—such as baseball, lacrosse, hockey—and can occur when the ball or puck strikes the chest. Contact sports that can result in trauma to the anterior chest also raise risk, Dr. Elfrey adds.
Treatment
The treatment for commotio cordis first includes quick diagnostic recognition. Any athlete that collapses after trauma to the chest should immediately be examined for a pulse, Dr. Elfrey states. If no pulse is identified, then prompt CPR with the concomitant use of an automatic external defibrillator (AED) is the life-saving treatment. The defibrillator will recognize the abnormal rhythm, and ventricular fibrillation, and deliver a shock to the heart to restore it to normal. The time that the heart is not beating properly, or is in ventricular fibrillation, is the time that the brain is not getting adequate oxygen. Therefore, prompt recognition and treatment are essential to survival and recovery prognosis, Dr. Elfrey explains.
According to Cleveland Clinic, tests that are done to diagnose commotio cordis include:
Electrocardiogram (EKG).Blood tests.Echocardiogram.Heart MRI or CT scan.Heart catheterization.
We’re relieved to hear that Hamlin “went through a comprehensive medical evaluation as well as a series of cardiac, neurological and vascular testing” prior to leaving the hospital. Next up: Doctors Name the 7 Types of Heart Conditions You Should Know About—and What to Understand About Each
Sources
Kaustubh Dabhadkar, a cardiologist with expertise in preventive cardiologyKate Elfrey, D.O., a cardiologist with The Heart Center at MercyMadias, C., Maron, B. J., Dau, N., Estes, N. A. M., 3rd, Bir, C., & Link, M. S. (2018). Size as an Important Determinant of Chest Blow-induced Commotio Cordis. Medicine and science in sports and exercise, 50(9), 1767–1771. https://doi.org/10.1249/MSS.0000000000001630Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Cheng, S., Delling, F. N., Elkind, M. S. V., Evenson, K. R., Ferguson, J. F., Gupta, D. K., Khan, S. S., Kissela, B. M., Knutson, K. L., Lee, C. D., Lewis, T. T., … Tsao, C. W. (2021). Heart disease and stroke statistics—2021 update. Circulation, 143(8). https://doi.org/10.1161/cir.0000000000000950 Cleveland Clinic: “Commotio Cordis”
