Department of Medical HistoryRediscovering commotio cordis
Section snippets
Contemporary commotio cordis
Commotio cordis is currently understood to mean “instantaneous cardiac arrest [that] is produced by nonpenetrating chest blows in the absence of heart disease or identifiable morphologic injury to the chest wall or heart”.3 Reports of the condition since the late 1970s are almost all from North America. Most describe accidental death of otherwise healthy children or adolescents after chest impact during recreational or competitive sport4, 5, 6, 7, 8 or, less frequently, during physical combat9
Commotio cordis, pre-1940s
The term commotio cordis was in use in textbooks as early as 1857.17 A review from 1896 shows that the term was applied to various forms (both lethal and non-lethal) of cardiovascular disorder caused by mechanical impact to the chest (both in the presence and absence of minor cardiac bruising).18 Case reports published in the 1870s include an account by an Italian doctor, Felice Meola, of a patient who died instantaneously after receiving a blow from a thrown stone to the upper sternum,19 and a
1940s–1970s
After World War II, studies of commotio cordis resumed slowly: it took about three decades for the total number of post-war publications to reach that of the 1930s alone. A fair proportion of such publications were in German accident or insurance-medicine journals, emphasising the driving force behind the studies.31, 32, 33, 34, 35 Reduced research capacity in post-war Europe should not be seen as indicative of disregard of commotio cordis among practitioners. The diagnosis was used in cases
History and renaissance
Both early and contemporary research into commotio cordis appear to have been motivated by case reports of sudden death. The combination of public interest and legal implications seems to have been a crucial driving force. Experimental designs, too, are similar. Conclusions were and are based on mechanically induced changes in electrocardiograms and blood pressure in anaesthetised animals subjected to precordial impact. The risk factors identified by Schlomka in the 1930s (type, force, and
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