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The Internet Journal of Thoracic and ISPUB.COM Cardiovascular Surgery Volume 15 Number 2

A Case of Commotio Cordis Caused by Horse Kick Z Karakaya, S Sa?ay, ? Demir

Citation Z Karakaya, S Sa?ay, ? Demir. A Case of Commotio Cordis Caused by Horse Kick. The Internet Journal of Thoracic and Cardiovascular Surgery. 2012 Volume 15 Number 2.

Abstract Sudden death in adults after non-penetrating chest blows are rare cases which are successfully resuscitated. Commotio cordis is the most described report during sporting activities in the youth. There have been very few reports of commotio cordis caused by other traumas. They endure a low survival rate. We reported a rare case of commotio cordis caused by a horse kick injury in a middle-aged male, who was successfully resuscitated and discharged without any neurological sequelae. This case can be classified as commotio cordis as the (VF) had developed immediately after .

The patient was a 46 year-old male who suffered a severe extubation had been performed by the ICU doctors. He was horse kick impact to the chest while examining the horse. He able to communicate and asked for discharge. Three days had no history of cardiac disease or other system diseases. after being accepted to the intensive care unit, he was The patient was transported to our hospital in a private car. discharged on his request. He arrived at the emergency room within 10 minutes of the DISCUSSION accident. There was no basic life support until he arrived. Evidence of ventricular fibrillattion led the doctor to carry According to American Registry, a total of 128 cases of out immediate with a biphasic defibrillator and Commotio Cordis occurring during sporting activities have started cardiopulmonary resuscitation. We performed now been reported as most victims being young males, but endotracheal intubation. Return of the spontaneous may also be seen in adults (1). Although once thought to be circulation was restored within 10 minutes of CPR, and exceedingly rare, Commotio Cordis is being reported with establishment of normal sinus rhythm was confirmed. The increasing frequency after chest wall blows (2). Commotio patient was immediately examined for internal organ injuries Cordis events are due to low impact, non-penetrating chest that might cause death. wall blows, most of which are not of sufficient force to cause any significant structural damage to the ribs, sternum, or General physical examination determined an 8 cm in length . An experimental model for Commotio Cordis suggests abrasion in the chest wall resulting from blunt trauma, and that the impact of projectiles on the chest wall of pigs during computerized tomography of the chest showed pulmonary the period of cardiac repolarization, prior to the peak of the contusion on the left lung. There wasn’t any , T wave typically induced ventricular fibrillation (7). The or in the imaging of the prompt detection of VF and the early defibrillation were the mediastinum. The patient was transported to our hospital’s keys to the successful outcome in this case. Contusio Cordis Intensive Care Unit. On arrival, he was hemodynamically is different from Commotio Cordis. Contusio Cordis is due stable and image studies were clear. The vital signs were to high impact blows that also result in injury to the above stable (blood pressure: 125/77 mmHg, heart rate: 88 bpm, structures of the chest and . Morbidity and mortality respiratory rate: 24 bpm, body temperature: 36.0 c). were seen as a result of myocardial tissue damage (6). Six Glasgow Coma Scale score was 3 (E1 V1 M1). Serum CK- cases of cardiac concussion have been reported in adult MB and Troponin I levels were normal. No evidence of any patients from vehicular accidents (3, 4) and one case has other critical injury was detected. The patient remained in been reported of Commotio Cordis caused by steering wheel the ICU for two days. During the clinical course, the patient injury (5). Three deaths due to blunt cardiac and chest remained hemodynamically stable and there was no trauma after vehicle accidents are presented where the only recurrence of arrhythmia. On day 2, he had woken up and significant injuries were contusions of the heart and fractures

1 of 3 A Case of Commotio Cordis Caused by Horse Kick of the sternum and ribs. One case had moderate coronary References artery atherosclerosis and another had a blood alcohol level 1. Maron BJ, Gohman TE, Kyle SB, Estes NA 3rd, Link of 0.218%. Given that individuals with cardiac bruising, MS. Clinical profile and spectrum of commotio cordis.JAMA. 2002 Mar 6;287(9):1142-6. chest trauma, coronary atherosclerosis, and alcohol 2. Geddes LA, Roeder RA: Evolution of our knowledge of intoxication may still die of the same mechanisms as in sudden death due to commotio cordis. Am J Emerg Med 2005;23:67-75. classic commotio cordis, and that these entities represent a 3. Michalodimitrakis EN, Tsatsakis JD, Aristidis M: spectrum of findings after chest impact, it may be more Vehicular accidents and cardiac concussıons: a traumatic useful to separate cases into related subcategories(8). Our connection. Am J Forensic Med 1997; 18:282-284. 4. Cotter G, Moshkovitz Y, Barash P, Baum A,Faibel H, patient showed pulmonary contusions on CT but that wasn’t Segal E.Ventricular fibrillation in the patient with blunt the cause of his cardiopulmoner arrest. Apart from these trauma: not always exsanguination. J Trauma 1996; 41:345-347. findings, we didn’t expect to find any reason in his medical 5. Kutsukata N, Mashiko K, Matsumoto H, Hara Y, history and findings of images and laboratory results. The Sakamoto Y, Koami H.J Nihon. A case of commotio cordis age of our case and the high energy chest trauma he was caused by steering wheel injuryMed Sch. 2010 Aug;77(4):218-20. exposed to may not be thought to conform to that of the 6. Madias C, Maron BJ, Weinstock J, Estes NA 3rd, Link Commotio Cordis patients identified so far, but the similarity MS. Commotio cordis--sudden cardiac death with chest wall impact. J Cardiovasc Electrophysiol. 2007 Jan;18(1):115-22 of the history and the findings in the physical examination of 7. Link MS, Wang PJ, Pandian NG, Bharati S, Udelson JE, our patient with typical commotio cordis cases makes us Lee MY, Vecchiotti MA, VanderBrink BA, Mirra G, Maron think that he may also be regarded within the same BJ, Estes NA 3rd. An experimental model of sudden death due to low-energy chest-wall impact (commotio cordis). N diagnosis. It has been reported that the previous Commotio Engl J Med. 1998 Jun 18;338(25):1805-11. Cordis cases involving adults may be considered again based 8. Marshall DT, Gilbert JD, Byard RW. The spectrum of findings in cases of sudden death due to blunt cardiac clinical evaluation rather than the age of the patient or the trauma--'commotio cordis'. Am J Forensic Med Pathol. 2008 severity of the trauma. Mar;29(1):1-4.

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Author Information Zeynep Karakaya, MD Emergency Medicine Dept., Adana State Hospital

Serkan Sönmez Sa?ay, MD Thoracic Surgery Dept, Adana State Hospital

?erafettin Demir, MD Cardiology Dept., Adana State Hospital

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