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Sudden Cardiac Arrest and Commotio Cordis


Sudden Cardiac Arrest

Cardiac arrest happens every day, over 1,000 times a day in the U.S., and to all ages, genders, and types of people. It is not selective to race, wealth, or health. Sudden cardiac arrest can happen anywhere, any time, and to anyone.


The chance of the cardiac arrest victim’s survival is not tied to the kind of professional status of the responder; paramedic, firefighter, nurse, etc. The chance of good neurological recovery is tied to whomever is nearest to the victim at the time of collapse. Help notified (911) and chest compressions must be started immediately! Any type of compression is better than no compressions at all. Pushing on the heart (chest) helps to keep the blood flowing. At the time of collapse there is plenty of oxygen in the blood, so ventilations are not important in the first few minutes but keeping the blood flowing at all costs is the priority. You cannot hurt someone with chest compressions if they don’t need the help with their heart, they will most certainly let you know…” Ouch”, is a good response.


If the cardiac arrest victim is in a ventricular fibrillation (VFib) rhythm, which you as the responder will not know, the only treatment to convert the heart rhythm is defibrillation (DFib). VFib needs DFib! So how do you know if the victim needs a shock? Attach an Automated External Defibrillator (AED) FAST! The AED is a small, super smart computer, that can analyze the victim’s heart rhythm and will offer a shock (DFib) if needed. For every minute that the shock is delayed, the victim has less chance of survival. Do not delay, you CANNOT hurt anyone with an AED.


Compressions and defibrillation should be offered to every person within 2 minutes, yes 2-minutes, that collapses unexpectedly. It is the only way the victim of sudden cardiac arrest will have a second chance at life. Most cardiac arrest victim are too young to die! But the opportunity rests with whomever is closest at that time. If you wait for professional responders, it will be too late. The power is in your hands...literally!


Current survival rates from cardiac arrest average around 10%, meaning one in 10 victims will survival to hospital discharge, and even less will recover completely neurologically intact. Cardiac arrest needs to be recognized, 911 alerted, and compressions started immediately to increase the rate of survival.


Causes of sudden cardiac arrest include: And it is Not a Heart Attack!


Structural or functional abnormalities of the heart or lungs:


1. Hypertrophic cardiomyopathy (HCM).

2. Arrhythmogenic right ventricular dysplasia (ARVD).

3. Coronary artery abnormalities.

4. Primary pulmonary hypertension.

5. Myocarditis/dilated cardiomyopathy.

6. Restrictive cardiomyopathy.

7. Marfan Syndrome with aortic dissection.

8. Aortic valve stenosis.

9. Other known at-risk congenital cardiac abnormalities.


Primary electrical abnormalities of the heart or lungs:


1. Long QT syndrome.

2. Brugada syndrome.

3. Wolff-Parkinson-White syndrome.

4. Primary or idiopathic ventricular tachycardia/fibrillation.

5. Adrenaline-induced or exercise-induced ventricular tachycardia.

6. Heart block (congenital or acquired)


Acquired conditions


1. Commotio cordis (sudden blow to the chest causing fibrillation).

2. Drug use: cocaine, stimulants, inhalants, fentanyl, antibiotics (Zithromax), Zofran.

3. Atherosclerotic coronary artery disease

4. Post operative congenital heart disease/heart failure


Signs and symptoms


Sudden cardiac arrest and death are major public health concerns. Sudden cardiac arrest is unpredictable, leading to the need for awareness and prevention. Outside of known risk factors such as smoking, poor diet and exercise habits, and use of drugs, there are numerous factors that may determine whether a student or adult should see a physician due to potential heart abnormalities.


Sudden cardiac arrest frequently has warning signs and symptoms that, at times, will go unnoticed. Particularly with children and adolescents, it is important to recognize the following:


Fainting (syncope) during or after exercise.

Dizziness/lightheadedness.

Excessive fatigue associated with exercise.

Excessive shortness of breath associated with exercise.

Heart palpitations/abnormal heart rate or rhythm (arrhythmia).

High blood pressure.

Congenital heart abnormality.

Obesity.

Diabetes.

Family history of sudden death prior to age 50 or known heart abnormalities.

Often, children and adolescents do not notify an adult about occurrences of the symptoms. It is important to monitor students who have a known congenital heart abnormality or are experiencing any of the signs and symptoms of sudden cardiac arrest.

Commotio Cordis:

Commotio cordis is a Latin word meaning agitation or disruption of the heart. Studies state it is a rare lethal disruption of heart rhythm that occurs because of a blow to the area directly over the heart at a critical time during a specific period of the heart rhythm. This leads to a disruption of the normal heart electrical activity, followed instantly by ventricular fibrillation or a complete disorganization of the heart's pumping function, and cardiac arrest occurs. It is not caused by mechanical damage to the heart muscle or surrounding organs and is not the result of heart disease.


My first experience with Commotio Cordis was a story of two 4-year old’s, playing in their front yard. They were playing and pretending to be gladiators and punching each other as in battle. One of the 4-year old’s punched the other in the chest, not hard, not fast, but at the specific time, and the child collapsed. Of course, no one expected this to occur, or knew why the child collapsed. 911 was called but compressions were not started because cardiac arrest was not expected.


Commotio Cordis is just another reason that someone can unexpectedly collapse. It does not matter the reason for collapse, treatment should always be the same. 911, chest compressions, and an AED Attached…Immediately!




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