The Achy Breaky Heart

Last week I started talking about blunt chest trauma and focused primarily on rib and lung injuries. Rib injuries are more common (bruised, cracked and/or broken), but with increased forces (for example falling from a height or at speed), associated lung injuries are possible too. But, I decided to leave blunt cardiac injury until this week. 

Blunt cardiac injuries are unlikely to occur on the trails, but it all depends on what YOUR trail activities entail. Ride like me? (slow) You're probably safe. Ride like you're in Red Bull Rampage? Well... 

Anyway, I was reviewing a continuing medical education course about blunt cardiac injury, and it mentioned what I had read previously--these types of injuries are more likely in motor vehicle collisions. That being said, downhill racer "Earthquake" Jake Watson died from cardiac trauma when he crashed from a jump and landed on his chest at the Keysville Classic in California in 1999. And "Other mechanisms, such as falls, crush injuries, assault, and sports related injuries with direct blows to the chest also contribute." Also, many people witnessed the dramatic events unfold when Damar Hamlin collapsed and his life was literally saved, so it's worthwhile to discuss.

Because of the forces needed to cause a blunt cardiac injury, the heart is usually just one of many organs damaged, including bones, lungs, spinal cord, brain... any and all of the above. 

Thinking specifically of the heart, injuries can be to the structures themselves, like the chambers (ventricles and atria), the walls between the two sides of the heart (septa), the valves between the chambers, or to the vessels around or coming out of the heart (coronary arteries, aorta). Injuries can also affect the electrical conduction of the heart and lead to abnormal heart rhythms--from minor to life threatening. 

One type of heart rhythm abnormality that I hinted at is called "Commotio Cordis," and it happens when the chest trauma happens at the exact right (or wrong) time during the normal cardiac cycle: Commotio cordis is a rare type of BCI resulting in sudden cardiac death in patients without pre-existing disease or morphologic injury. It is the second most common cause of death in athletes aged < 18 years and is caused by blunt trauma to the precordium that induces ventricular fibrillation, but it may also present with ventricular tachycardia. In a case series of 25 patients who experienced cardiac arrest immediately following an unexpected blow to the chest, 16 cases were related to competitive sports and 9 cases were related to recreational activities at home, school, or on the playground.

It's rare, but not unheard of.

In cases of commotio cords, CPR and defibrillation are key, and that's what saved Damar Hamlin's life. In most other occurrences, the stars may not be as well aligned. 

And on a similar somber note, the only real intervention that can help someone with any other cardiac injury is rapid transfer to a trauma center. Which, let's face it, if someone had the type of trauma that has injured the heart, he/she ins't going to want to keep going on the trail, and most bystanders with any sense are going to immediately call 911 for help. 

So really, that's the take home message. Be aware that trauma to the chest can affect the heart, either anatomically or electrically. Either one may be fatal without immediate interventions such as CPR/defibrillation or other surgical procedures, but some will be minor enough to need nothing more than a thorough evaluation in a hospital with things like electrocardiograms, blood tests, X-rays, CT scans or cardiac ultrasounds. 

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