January 3, 2023
Few medical details about Buffalo Bills safety Damar Hamlin’s cardiac arrest have been made public, but the circumstances around the NFL player’s shocking collapse have many doctors speculating that he may have suffered from this specific cardiac event.
Doctors who have been following the story of Hamlin’s collapse have frequently mentioned commotio cordis as a likely cause.
Commotio cordis is the sudden low to mild impact to the chest wall at a certain point in the cardiac cycle that can induce a sudden life-threatening heart arrhythmia or cardiac arrest.
The condition is seen mostly in young athletes between the ages of eight and 18 who participate in sports that involve projectiles such as baseball, hockey and lacrosse, according to the University of Connecticut’s Korey Stringer Institute.
Adults over the age of 20 (Hamlin is 24) are less susceptible to the condition as medical professionals believe it’s due to the stiffening of the chest wall, though other theories suggest the numbers could be skewed because fewer adults over 20 participate in such sports, reports the American Heart Association Journal.
According to the National Center for Biotechnology Information (NCIB), 95% of those who have suffered from the condition are boys, likely because they participate in such sports activities in higher numbers at a young age.
One of the main ways to save an athlete who might be experiencing commotio cordis is resuscitation with an automated external defibrillator (AEDs), and the success rate of survival if treated immediately exceeds 50% according to the NCIB.
The NCIB also reports a discrepancy between the survival rate of African-Americans (4%) compared to whites (33%), mostly attributed to delayed resuscitation efforts (44% vs. 22%) and less frequent use of AEDs (4% vs. 8%).
So far, there are less than 30 cases of commotio cordis reported each year according to the NCIB, although it is being increasingly recognized, and the Minneapolis Heart Institute Foundation created the U.S. Commotio Cordis Registry to aggregate information on the condition.
“It has to be a perfect storm of events where there’s an impact to the chest wall overlying the heart with just enough force, and what’s most critical is the timing,” Dr. Christopher Madias, the director of the New England Cardiac Arrhythmia Center at Tufts Medical Center, told NPR’s Morning Edition. “It happens within a critical period within the cardiac cycle. We’re talking about 20 to 30 milliseconds within the cardiac cycle that the heart is vulnerable to this.”
The condition has long been reported since the 18th century, primarily reported among workers who experienced chest trauma, though it came into prominence during the 1990s following a 1995 report by The New England Journal of Medicine detailing the phenomenon.
So far, the U.S. Commotio Cordis Registry has reported 224 cases between 1995 and 2010 according to a 2010 report by the NEJM.
Heart disease is the leading cause of death in the U.S. according to the Centers for Disease Control and 17.9 million global deaths were attributed to cardiovascular disease in 2019, reports the World Health Organization. Not all heart disease is equal as there are differences between a heart attack and cardiac arrest. A heart attack occurs when an artery is blocked and prevents blood from flowing to a certain section of the heart and, unlike cardiac arrest, does not stop the heart from beating. Cardiac arrest is sudden and often without warning, caused by electrical malfunction of the heart leading to an irregular heartbeat (arrhythmia). With pumping disrupted, blood flow to other major organs stops, and a person can lose consciousness and have no pulse, according to the AHA.