By Donna M. Pacicca, MD and Ray Lorenzoni III, MD (Connecticut Children’s)
All parents of aspiring athletes think about their child’s safety—it’s only natural. But when events like what happened to Buffalo Bills’ Damar Hamlin take over the headlines, we can’t help but ask questions. Why did this football player’s heart stop on the field at just 24 years old? Was this a true heart attack? How likely is this to happen to my teenager or young adult? What is “commotio cordis,” anyway?
Connecticut Children’s sports medicine and cardiology experts teamed up to address these questions and more.
What is commotio cordis, and how common is it?
Dr. Lorenzoni: First, we do not know for sure that what we saw in the Buffalo game was commotio cordis, but it is a likely diagnosis. Commotio cordis can be a cause of something called “Sudden Cardiac Death”, which is a category of emergencies that often involve an abnormal heart rhythm and can lead to cardiac arrest. This is a bit different than what usually happens during a “heart attack” that we might be more familiar with.
Commotio cordis is extremely rare. Out of the millions of athletes in this country, only about 30 cases are reported each year. Commotio cordis affects mostly male athletes 8 to 20 years old who are in activities that could involve a strong impact to the chest. On average, only about 50% of people survive. You can increase the chances of survival with quick treatment, like we saw with Damar Hamlin.
It’s important to understand that you are not “born with” commotio cordis. It is not a type of heart disease, and it is not genetic or inherited. It can occur in anyone who gets hit hard in the front of the chest, but it happens more often in older children and young adults who are in these types of activities.
How exactly does the injury resulting in commotio cordis play out on the field?
Dr. Pacicca: As Dr. Lorenzoni mentioned, commotio cordis is extremely rare. Here’s why: You’d have to get hit in the front of the chest, right over the heart. Quick blast from the past from high school biology… your heart is in the center-left part of your lower chest. The risky area of the chest is only a couple inches wide. This is getting pretty precise.
Explain “getting hit in the chest.” What does that look like?
Dr. Pacicca: Athletes can experience commotio cordis from things like a baseball, a hit during football (as we know), a hockey puck, or a lacrosse ball. The force has to be pretty strong, typically an object travelling more than 30 miles per hour or an unlucky tackle.
What happens to the body during commotio cordis and what are the symptoms?
Dr. Lorenzoni: Again, commotio cordis is unlikely—and another reason is because the hit to the front of the chest would need to happen at the exact right time in its rhythm. In other words, the lower heart chambers (the ventricles) have to just start relaxing after a heartbeat.
Here’s how it happens:
-The athlete gets the strong, unexpected hit to the front of the heart during the few milliseconds the lower heart chambers are relaxing.
-The blow sends an abnormal signal to the heart’s ventricles and makes them contract when they are supposed to be at rest.
-The heart goes into a disorganized rhythm, which can lead to cardiac arrest. So, the classic symptoms of commotio cordis are heart palpitations, shortness of breath, feeling light-headed, and/or losing consciousness soon after getting hit in the chest.
What can athletes do to protect themselves from commotio cordis?
Dr. Pacicca: Lots of things. Encourage your athletes to speak up! Now is the perfect time to ask coaches for training sessions to recognize the signs and symptoms of commotio cordis. When signing up for a new sport or team, always ask about their emergency action plan because injuries happen!
The best way to treat someone experiencing a potential Sudden Cardiac Death emergency (including commotio cordis) is to:
- Call 911 if an athlete becomes unresponsive and does not wake up within a few seconds,
- Start the steps of resuscitation (CPR) as quickly as possible,
- Have quick access to an automated defibrillator (AED), apply the pads to the chest, and follow the simple instructions as soon as it’s available.
And always, always use the protective gear recommended for your sport, even if it’s not necessarily designed for commotio cordis.
Want even more information? Here is some additional reading: