The spectrum of findings in cases of sudden death due to blunt cardiac trauma--'commotio cordis'.

Commotio cordis is a term used for cases of sudden cardiac death due to nonpenetrating chest trauma without evidence of underlying myocardial disease or injury. Contusio cordis has been reserved for cases of chest trauma where there is cardiac bruising. Three deaths due to blunt cardiac and chest trauma after vehicle accidents are presented where the only significant injuries were contusions of the heart and fractures of the sternum and ribs. One case had moderate coronary artery atherosclerosis and another had a blood alcohol level of 0.218%. Given that individuals with cardiac bruising, chest trauma, coronary atherosclerosis, and alcohol intoxication may still die of the same mechanisms as in classic commotio cordis, and that these entities represent a spectrum of findings after chest impact, it may be more useful to separate cases into related subcategories: (A) those with no evidence of injury or underlying cardiovascular disease, (B) those with chest wall fractures, chest wall contusions and/or cardiac contusions, and (C) those with underlying cardiovascular disease or the presence of substances such as alcohol or drugs that may reduce the threshold for cardiac arrhythmias. As there may be cases with a number of these factors, a fourth category (D) includes those with a combination of injuries and predisposing factors (ie, categories B and C). Including cases such as these under the diagnostic umbrella of commotio cordis may demonstrate that a wider range of individuals are at risk for death from blunt cardiac trauma than sports-playing adolescents.