Blunt Chest Wall Trauma Leading to Sudden Cardiac Arrest (JACC Case Reports September 2024)-Article: Blunt Chest Wall Trauma Leading to Sudden Cardiac Arrest

Article: Blunt Chest Wall Trauma Leading to Sudden Cardiac Arrest

Pdf Summary

A 54-year-old hockey player sustained blunt chest trauma from a slapshot, leading to a sudden cardiac arrest (SCA) on the ice. Immediate cardiopulmonary resuscitation (CPR) and defibrillation via an automated external defibrillator (AED) restored sinus rhythm. The player was later found to have a rectangular mark from the puck on his precordial chest wall and subclinical single-vessel coronary artery disease (CAD), suggesting a possible but unconfirmed coronary dissection.<br /><br />The patient’s past medical history included occasional smoking but no known history of cardiovascular problems or previous cardiac evaluations like ECGs or stress tests. He regularly played hockey with no prior incidents of angina. Upon hospital examination, no pneumothorax or rib fractures were identified, and neurological functions were intact. Elevated troponin levels indicated a minor myocardial infarction, but angiography revealed severe occlusions in the left anterior descending (LAD) artery. Successful stenting was performed on the proximal LAD lesion, though intervention on the distal portion was unsuccessful.<br /><br />Mechanisms contributing to the VF include commotio cordis—a rare but critical condition where a sudden, blunt impact to the chest leads to fatal arrhythmia, particularly if it coincides with a specific phase of the cardiac cycle. High-impact experimental models and reports suggest that factors like the impact’s intensity, location, and timing are crucial. Moreover, CAD, despite being previously undiagnosed, was a significant factor noted in this middle-aged athlete’s cardiac arrest.<br /><br />The case emphasizes the critical need for prompt emergency actions and the availability of AEDs at sports venues, as expeditious defibrillation greatly improves survival rates. Furthermore, the 10-year follow-up showed the patient experienced no further cardiac issues, highlighting the significance of managing cardiovascular risk factors for long-term health. The case underscores the dual importance of protective sports gear and vigilance regarding underlying silent coronary diseases in athletes.

Keywords

hockey player

blunt chest trauma

sudden cardiac arrest

cardiopulmonary resuscitation

automated external defibrillator

coronary artery disease

commotio cordis

myocardial infarction

coronary dissection

protective sports gear