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Sudden Death in Young Athletes After Blunt Chest Trauma

Sudden, unexpected, nonpenetrating blunt trauma to the anterior chest wall in the absence of structural heart disease or myocardial damage appears to precipitate sudden death in a few unfortunate young athletes. Using records from several sources, Maron and colleagues characterized 25 of these tragic cases (age range, 3 to 19 years).

Deaths were most frequently associated with baseball (16 of 25), with a batter commonly being struck mid-chest by a pitched ball. The sport next most often involved was hockey (4 of 25). Almost half (12 of 25) the total studied victims collapsed immediately after an unexpected blow to the chest; the others had brief periods of consciousness. Resuscitation efforts were begun promptly in 19 of the 25 victims, but none survived without irreversible brain damage; 28% were wearing protective chest padding at the time.

Autopsies on 22 victims showed no significant structural heart disease; toxicology screens on 15 were negative. ECGs, which might have revealed whether conduction abnormalities had been present, were unavailable.

Comment: While this article adds substantially to our information about these catastrophic events, frequency of such events cannot be determined in the absence of a comprehensive registry. The mechanism is also unknown, although it may be that a ventricular arrhythmia occurs when energy is transferred to the heart at a vulnerable period in the cardiac cycle. This study should prompt efforts to collect more information about the prevalence and mechanism of these events to determine whether they are preventable.

— HM Krumholz

Published in Journal Watch Cardiology September 1, 1995

Citation(s):

Maron BJ et al. Blunt impact to the chest leading to sudden death from cardiac arrest during sports activities. N Engl J Med 1995 Aug 10 333 337-342.

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