Commotio cordis: early observations
- University of Oxford
- University Laboratory of Physiology
- Parks Road, Oxford OX1 3PT, UK
- email: peter.kohl{at}physiol.ox.ac.uk
Editor,—Commotio cordis (arrhythmia or sudden death caused by a blunt, non-penetrating, precordial impact without structural damage) is not as new a phenomenon as frequently assumed.1 Case reports can be traced back in the European medical literature for at least 130 years.
In 1879 Meola described how one of his patients died suddenly after the impact of a stone throw to the Manubrium sterni.2 Nélaton’s observation in 1876 of sudden death in a manual labourer after blunt precordial impact (his chest hit the ground when a towing yoke he was pulling snapped) was followed up by a postmortem examination that did not reveal any signs of structural damage to the organs of the chest.3
Subsequently, a series of publications by Riedinger4-6and Reinebroth7 addressed the issue of differences between blunt chest impact with and without structural damage. Much of the interest in such discrimination originated from disputes in assessment of claims under German occupational accident compensation and pension schemes of that time.
Later, extensive experimental work by Schlomka and colleagues8 9 showed that the arrhythmogeneity of blunt precordial impact without structural damage was proportional to the swiftness and the force of the mechanical stimulation, and inversely related to the size of the contact area. They also established that mechanically induced sudden cardiac death could be observed even after bilateral vagotomy. They concluded that mechanical impulse transmission from the chest to the heart is the causal event in mechanically induced arrhythmogenesis, and that non-neural factors play a substantial role in this process. The underlying mechanism is now referred to as mechanoelectric feedback and has been reviewed in detail elsewhere10 11
Interrupted by the second world war, the subject received renewed attention in Europe in the 50s and 60s (for an outline of related communications see Isfort’s paper on commotio cordis in the child, published in 196912). This is also approximately the time at which the subject started to receive more attention in medical and research papers published in English.
Thus, while recent observations of commotio cordis fatalities during competitive sports such as baseball and ice hockey have heightened public awareness, this is by no means a new condition. It has been discussed for well over a century, and it is amazing to see some of today’s understanding of this issue reflected in the earliest publications we have access to.
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