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BUFFALO BILLS SAFETY Damar Hamlin remains in critical condition, after going into cardiac arrest following a hit during a game Monday night against the Cincinnati Bengals. Some experts believe the impact to his chest could have triggered a cardiac episode, called commotio cordis.

“Commotio cordis is related to ventricular fibrillation, when the heart completely stops,” explains Matthew Martinez, M.D., F.A.C.C., director of sports cardiology and co-director at the Chanin T. Mast Center for Hypertrophic Cardiomyopathy at Morristown Medical Center in the Atlantic Health System. “It’s the result of a traumatic chest-wall impact.”

While it’s more common among young athletes, especially baseball players that might get hit with a ball, it’s a very rare condition, with only about two dozen cases reported every year. And, it doesn’t just happen in sports—any blow to the chest that occurs at a specific time and lands in just the right place can trigger commotio cordis.

“This is a poorly timed event,” Dr. Martinez says. “It lands at a time when the heart is vulnerable to being put in cardiac arrest, what we call on the T Wave, when the heart is resetting itself.”

Commotio cordis is often deadly. Swift action to administer CPR and shock the heart with an automated external defibrillator (AED) can increase someone’s chance of survival in these instances. Medical personnel attended to 24-year-old Hamlin for ten minutes, and according to the Bills, his heartbeat was restored on the field before he was rushed to the hospital by ambulance.

The team said Hamlin went into cardiac arrest—but, no one has said for sure whether he experienced commotio cordis. He was transferred to the University of Cincinnati Medical Center, where he’s undergoing testing and treatment. He’s sedated and listed in critical condition.

Cardiac arrest can occur suddenly, even in people who seem healthy and don’t have existing heart problems, and recovery is possible. Here’s a look at what exactly cardiac arrest is, why many experts believe commotio cordis could have played a role in Hamlin’s case, and what it might be like to recover from the condition.

What Is Cardiac Arrest?

Cardiac arrest refers to a sudden loss of heart function—and, the person experiencing it may or may not have existing heart problems or a heart disease diagnosis, according to the American Heart Association. It can happen suddenly or along with other symptoms.

It can be deadly. But, it’s also reversible if CPR is performed immediately and an AED is used to shock the heart to help restore its normal rhythms.

Any bystander who witnesses someone going into cardiac arrest should call 911, start CPR, use an AED, and not stop until emergency services arrive, Dr. Martinez says.

Cardiac arrest is fairly common, causing 300,000 to 450,000 deaths in the U.S. each year, according to the National Heart, Lung, and Blood Institute. It can be caused by:

  • Electrical abnormalities in the heart
  • Heart tissue scarring
  • Heart muscle thickening
  • Blood vessel abnormalities
  • Heart medications
  • Drug use
  • Commotio cordis, in rare cases (more on that below)

Cardiac Arrest Isn’t a Heart Attack

Cardiac arrest and heart attacks aren’t the same, though the terms are often used interchangeably.

Cardiac arrest is caused when the heart’s electrical system malfunctions and the heart stops beating properly.

A heart attack is usually caused by a blockage that restricts or stops blood flow to the heart. The loss of blood supply causes heart muscle tissue to die.

What Is Commotio Cordis?

When someone takes a hard hit to the chest, it can trigger a change in the heart’s rhythm that often results in sudden death. This is known as commotio cordis.

The condition doesn’t necessarily damage the heart muscle—it changes the heart’s electrical signals, according to the Mayo Clinic. It can happen even when someone doesn’t have a pre-existing heart condition.

Commodio cordis is a “diagnosis of exclusion,” Dr. Martinez says. Doctors confirm that there was a blow to the chest, and that the heart was structurally normal before and after the impact.

Professional athletes often undergo heart screenings to identify any heart problems.

“But, there’s no screening process that’s ever going to identify somebody who’s at risk for commodio cordis,” Dr. Martinez says. “That underscores the need to have an emergency action plan and a defibrillator in place.”

Commotio cordis is rare, but it’s said to be the leading cause of sudden cardiac death among young athletes. Still, there are just about 30 reported cases a year. The National Commotio Cordis Registry was created to track cases.

The condition tends to be linked to sports, but any blunt chest injury, such as from a car accident or fall, could cause commotio cordis.

The timing and location of the impact matters, too. It has to occur during a heartbeat and hit near the center of the heart’s left ventricle, or lower heart chamber. Striking at a specific time can trigger ventricular fibrillation, or an irregular heart rhythm.

Symptoms of Commotio Cordis

Someone experiencing commotio cordis might stumble, lose consciousness, and collapse after taking a blow to the chest. That’s similar to Hamlin’s reaction on the field.

There likely won’t be visible trauma to the chest. And, someone might stop breathing.

Can You Recover From Commotio Cordis?

It is possible to recover from commotio cordis if immediate action is taken after the hit to the chest. CPR and using an AED as quickly as possible offer the best chance of survival.

“Shocking someone back into normal rhythm is the only successful way to undo a blunt trauma to the chest, or commodio cordis,” Dr. Martinez says.

For every minute of delay in being shocked by an AED, the survival rate drops 10%. Continued AED use and CPR until emergency services arrive are recommended.

Research shows that resuscitation within three minutes led to a survival rate of 25%, but when it goes beyond three minutes, the survival rate drops to 3%.

Most people who survive commotio cordis recover and can return to playing sports or participating in other activities following an episode. Because someone who experiences it has a normal heart, there’s usually no long-term damage.

Though, there’s the potential that you could suffer another impact if you return to the same activity, Dr. Martinez says.

He emphasizes that commotio cordis is rare—and, playing sports and exercising is good for your heart. “Exercise is medicine,” Dr. Martinez says. “There’s a mountain of data to support exercise for not only the prevention of cardiac arrest and cardiac events, but those who have them, who are exercisers, do better than those who aren’t.”

If you have a family history of heart disease or cardiac events, or are experiencing symptoms, like chest pain, high blood pressure, or shortness of breath, it’s a good idea to get your heart screened.

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