Нарушение сердечного ритма от удара в грудь

Disruption of heart rhythm from a blow

Commotio cordis (Latin, "agitation or disruption of the heart") is a rare disruption of heart rhythm that occurs as a result of a blow to the area directly over the heart (the precordial region) at a critical instant during the cycle of a heartbeat. The condition is 97% fatal if not treated within three minutes.

There are only 1020 cases annually in the United States. This increase is likely due to prompt CPR, access to defibrillation, and higher public awareness of this phenomenon. Higher survival rates correlated with immediate resuscitation by using CPR and an on site automated external defibrillator—the survival rate was forty percent if resuscitation was performed within three minutes of the impact injury, contrasted with only five percent survival if resuscitation was delayed to more than three minutes after the impact. From 1996 to spring 2007, the US National Commotio Cordis Registry had 188 cases recorded, with about half occurring during organized sports. Almost all (96%) of the victims were male, the mean age of the victims during that period was 14.7 years, and fewer than one in five survived the incident. Pronger made a full recovery after an overnight stay at Henry Ford Hospital in Detroit and would be cleared to play again four days later. The incident ultimately had a negligible effect on his career, which lasted until 2011. Another high profile incident occurred on January 3, 2023 during Monday Night Football when Buffalo Bills safety Damar Hamlin experienced commotio cordis after Cincinnati Bengals wide receiver Tee Higgins's helmet struck him in the chest as he was making a tackle. Hamlin collapsed and went into cardiac arrest, and his life was saved by the Bills' training staff administering CPR and employing an automated external defibrillator (AED).

In experimental animal models in pigs studying impacts by a hard ball to the chest wall, impacts that occurred directly over the center of the left ventricle, where there is no overlying lung tissue, were the most likely to cause ventricular fibrillation. In contrast, the precordial thump (hard blows given over the precordium with a closed fist to revert cardiac arrest) is a sanctioned procedure for emergency resuscitation by trained health professionals witnessing a monitored arrest when no equipment is at hand, endorsed by the latest guidelines of the International Liaison Committee on Resuscitation. It has been discussed controversially, asin particular in severe hypoxiait may cause the opposite effect (i. e., a worsening of rhythm—commotio cordis). In a normal adult, the energy range involved in the precordial thump is five to ten times below that associated with commotio cordis.

The deviation of commotio cordis from the normal electrical rhythm of the heart is assessed scientifically in laboratory studies by analysis of the electrocardiograph (ECG) T wave (see ECG image). Since the trailing edge of the preceding electrical cycle travels over the ventricular surface, the critical window for mechanical induction of ventricular fibrillation varies locally across the ventricle. Chest protectors and vests are designed to reduce trauma from blunt bodily injury, but many commercially available chest protectors do not offer protection from commotio cordis and may offer a false sense of security. In 2017, the National Operating Committee on Standards for Athletic Equipment (NOCSAE) finalized a new standard outlining outlining performance requirements and test methods for chest protectors used in baseball and lacrosse, ND200 Standard Test Method and Performance Specification Used in Evaluating the Performance Characteristics of Chest Protectors for Commotio Cordis. Beginning in 2021, US Lacrosse made chest protectors that meet the NOCSAE ND200 standard a requirement for all goalies, and expanded coverage in 2022 to require all players to wear such a chest protector. In 2018, the National Federation of State High School Associations (NFHS) changed their baseball rules to require the catcher to wear a chest protector that meets the NOCSAE ND200 standard requirements.

Automated external defibrillators (AED) and prompt CPR helped to increase the survival rate to 58 percent.

Several people have been charged and convicted for the deaths of victims of commotio cordis, even when the blows rendered were never given with an intent to kill. In 1992, Italian hockey player Miran Schrott died after a blow to his chest from the stick of Italian Canadian player Jimmy Boni. Boni was charged with culpable homicide, and eventually pleaded guilty to manslaughter, paying a $1,300 fine and $175,000 restitution to Schrott's family.