Heart :: Chest blows can be fatal even with protective gear

Youth league coaches and parents may feel reassured when their athletes wear commercially made protective gear, but researchers in Minneapolis warn that standard equipment may not protect the heart adequately against hard contact.

Athletes in sports involving sticks, balls, pucks or aggressive competition are at risk for commotio cordis, a blunt, nonpenetrating blow to the chest that triggers ventricular fibrillation.

A study of 85 commotio cordis cases that occurred since 1995 during organized practice or competition found that fatal chest blows occurred despite potentially protective equipment in 33 cases (39 percent).

Study data, released at Scientific Sessions, were from a registry at the Minneapolis Heart Institute Foundation?s Hypertrophic Cardiomyopathy Center.

In 23 deaths, padding did not cover the chest where the blow struck, and in 10 the projectiles directly struck the chest protector.

Of the 33, there were 14 hockey players, including two goalies; 10 football players; six lacrosse players, including three goalies; and three baseball players, all of them catchers.

The average age of the athletes was 15 years.

?The difference between a benign blow and commotio cordis is timing,? said Barry J. Maron, M.D., senior author of the study and founder and director of the Hypertrophic Cardiomyopathy Center. ?If the blow occurs directly over the heart at a particular time in the heart?s cycle, the results can be catastrophic.?

Dr. Maron said the athletes wore standard, commercially available chest barriers made of polymer foam covered by fabric or a hard shell. These are generally thought to provide protection from the consequences of chest blows, he said.

He said that it is important for parents to realize the risks their children face on the sports field. As well, coaches and managers must be able to recognize commotio cordis when it occurs and call for resuscitation and defibrillation.

Dr. Maron is hopeful that the data will represent a stimulus for developing an effective chest barrier ?that will be absolutely protective against the risk of these commotio cordis catastrophes.?

Other research supports Dr. Maron?s findings. In studies with an experimental model of commotio cordis developed at the New England Medical Center and Tufts University School of Medicine, researchers could produce ventricular fibrillation by a baseball moving 30 mph, but only if the impact occurred directly over the heart during the 20 millisecond window when the ventricles relax. This might explain why these events, although tragic, are rare.

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