Monday, June 4, 2012

Medical Mondays: The Death Strike

Oh the heart. That delicate package of muscle, blood, vessels and electricity.

We've probably all heard of stories of people getting hit in the heart and dying. Sadly, it's happened to many young athletes. Does this sound famliar?

A young, 15 year old boy is playing baseball when he accidentally gets hit directly in the chest with the ball. He falls unconscious and the coaches call 911 and grab an emergency AED (automated external defibrillator). Despite CPR and using the AED, the boy dies. 

Many writers are tempted to use it a means to kill of characters. After all, a simple blow to the chest as a way to instantly kill someone? What could be more dramatic, right?

So let's talk about it.

Commotio Cordis (Latin for "agitation of the heart") is the technical name for this phenomenon.

There are a lot of things that have to be just right for Commotio Cordis to occur and cause a fatal arrhythmia (ventricular fibrillation).
  • the object hitting the victim can be another person (football) or an object. When it's a projectile, it' usually solid, like a hockey puck or baseball, though occurrences with soccer balls do occur (more outside the US than here).
  • it has to hit precisely over the heart--not a few centimeters to the left or right.
  • the velocity has to be just so--the closer to 40 mph the more likely it will happen. Too slow or too fast, and it won't.
  • the timing has to be just right. The projectile must hit precisely during a tiny window of the cardiac cycle, specifically during the upslope of the T wave. You know those squiggly lines on the EKG you see on those medical shows? Well, down there in the orange area, in the midst of a single heart beat, is when this phenomenon occurs. It's about a 20-40 millisecond window of time.
From Wikipedia
Here are a few more useful factoids:
  • Sadly, protective chest wear does not prevent this from happening
  • Only 25% of people who suffer from this actually survive, but hopefully this number is increasing with the rapid use of CPR and AEDs.
  • it's hard to pinpoint how often this happens, but the ones most often affected tend to be young males under the age of 25.
  • It most often happens during impact sports, including football
  • though the heart beats faster during physical activity, the window of vulnerability on the cardiac cycle doesn't shorten. Thus, the window occurs more often when the victim is physically active. Another reason why sports make this more of a risk factor.
Why does it happen? There is a theory that the impact triggers activation of an ion channel in the heart muscle which causes the fibrillation to occur.


The bottom line? If you're going to use it in fiction, use it judiciously. It has to make sense if it's going to happen to your poor character. 

Finally, a thank you to Indies Unlimited, whose post inspired mine. :)

If you've got a fictional medical question, let me know! Post below or email me at
  All I ask is that you become a follower and post a link on your blog when I post your answer. This is for fictional scenarios, only. Please check out the boring but necessary disclaimer on my sidebar ---> Also, don't forget to stop by Laura Diamond's Mental Health Mondays and Sarah Fine's The Strangest Situation for great psychiatric and psychological viewpoints on all things literary. :)

41 comments:

Old Kitty said...

Oh this is way too dramatic for me!! And really scary! So thank you for the fine details and info!! Awesome as always!

Oh and I love your very pretty new look blog! Yay! Take care
x

Alex J. Cavanaugh said...

In a book, it might be viewed as a contrivance rather than freak accident. Sad that it really happens though.

Kimberlee Turley said...

If I read this in a book, I'd wonder why the author didn't just have lightning strike the person, or to just have them die in a car accident.

Natalie Aguirre said...

That's so sad that protective wear can't avoid this. Because it is a tragic way to die and as a parent you'd want to try to avoid this happening to your kid.

I doubt I'd ever use this in a book. It's such a sad, weird way to die. Thanks for sharing about it.

Clarissa Draper said...

Wow, fascinating. However, it would be a difficult thing for a killer to pull off. There are so many factors to consider. Thank you for this wonderful post.

SA Larsenッ said...

Loving your factoids. But I always do. Great post!

Carol Kilgore said...

Love Medical Mondays. This falls into being in the wrong place at exactly the wrong time.

Karen Lange said...

Appreciate the info. None of my characters in my WIP die. Or yet, anyway, but I'll file this away for future reference.

Carolyn Abiad said...

Sounds horrible. If this happened to a character, I think I'd be writing about the people he left behind.

LTM said...

oh my goodness, Lydia! I almost couldn't finish this post! It was upsetting me that much, and I'm a zombie! ;p I'm going to eat my brains over here and try to stop thinking about this... *nom nom nom*

(something so disturbing; I foresee this being used... ;o)

Ghenet Myrthil said...

I've seen a bunch of news stories about this. So sad!

Precy Larkins said...

Wow, what an interesting way to die. It has to be precise and accurate. So sad about the boy who died. Thanks for sharing this info.

lbdiamond said...

This recently happened to a local kid. VERY sad. :(((

Rachna Chhabria said...

This happened sometime back in India. A football player had a heart attack on the field. Its really sad.

Emy Shin said...

This is fascinating, but really, really sad and scary. The risk of it happening is small, but the fact that you can't do anything to eliminate the risk except not playing sports altogether is terrifying.

P.S. I had a geeky moment when I went, "I totally recognize that diagram from my Human Phys class!"

Linda Gray said...

Oh, this is so sad. I'm glad there are significant mitigating factors--esp. that there's only a tiny window during a given timeframe when the heart's rhythm would be at the exact moment of vulnerability. Still, so sad!

Krispy said...

Ooh, great factoid! That's also scary! Like so many random things can go wrong with your body. :P On the other hand, is this finally a plus side to my laziness/lack of affinity for sports? Haha.

Btw, I love your new blog layout!

LD Masterson said...

I found this very interesting as a writer but terrifying as a woman with grandkids who play sports.

vbtremper said...

My sons will never play football. I'm putting my foot down.

This is the kind of cause of death that could easily become a cliche in fiction. But it would also make an awesome red herring!

-Vicki

Meredith said...

How horrible! And how strange that it has to be at just a certain velocity. Very interesting (but no, I won't be using it in my writing--too sad for my style!).

Coleen Patrick said...

At first I was thinking about the crocodile guy--steve irwin maybe? Because the ray's stinger got him in the heart. I think. But I'd never heard about a sudden impact on the heart. Scary--and makes me glad my kids don't play contact sports.

Alleged Author said...

Very interesting. I didn't know so many factors were involved in something like this. Good thing I'm not planning to kill my characters this way!

Deb Salisbury said...

Wow! Fascinating! A boy at my high school died under those conditions, but "they" called it a heart attack. I didn't know what (might have) caused his death.

Jadi said...

That would be a good way for a villain who had this sort of knowledge to kill somebody and make it look like an accident, because, yes it is possible and it wouldn't like it really was the villian's fault...

I think I just got an idea.

Thanks for sharing this.

Roland D. Yeomans said...

I had my Lakota shaman kill fae attackers by striking directly over the heart with a large electric charge. I don't know if that would kill, but it seems like it couldn't feel good!

In my fantasy world, I had to come up with an explanation that at least made sense to me as to why vampires who do not oxygen-bearing blood pumping to the brain could actually keep their higher brain functions.

Gee, the things you think about as a fantasy writer late at night!

I turned to chi. Vampires were actually energy beings. Manipulating their chi through accupressure and acupuncture could hurt and kill them in a pseudo-scientific way. And a ball-bearing throwing teen like Victor Standish had a weapon to use against the things that go bump in the night!

Great Medical post as always! Roland

JEFritz said...

What a frightening thing. I've read about a few cases of this over the past few years. I hope it just seems to happen more than it does.

Nancy Thompson said...

I used an auto accident and blunt force trauma to kill my MC's wife. I have a whole emergency room scene where the docs are trying to resuscitate her. She's in asystole and shocking won't do any good.

When one doc asks the other what he thinks, he says, “Blunt force trauma like this, could be tension pneumo, aortic dissection. Take your pick.”

I hope I didn't blow it because once it's published in October, I'm sure someone will tell me!

I should have asked you first. DOH!

Shelley Munro said...

This is all news to me. Very interesting though!
I'm off to study your medical archives since I want ideas for killing someone off yet the death appearing natural. I'm sure you'll have something suitable :)

Angela Brown said...

There are so many ways to die that it's overwhelming to consider sometimes. But I appreciate your explanation. It helps to understand better because, in my ignorance, I couldn't understand why this was happening to healthy, active young men.

Carrie Butler said...

So sad! It was an interesting explanation, though. :) Thanks, Lydia!

Leslie Rose said...

Fascinating and terrifying. I'm so glad my kids weren't into sports. Phew.

Maurice Mitchell said...

Lydia that's fascinating. Considering the number of factors its hard to believe it ever happens, but it does. Wild.

Heather said...

How scary, I had no idea about this! But it does make sense, knowing about defib and all. It's a good thing AED's are becoming more common everywhere. They even carry them in the trunks of police vehicles now!

The Golden Eagle said...

Interesting--I've never actually heard of someone dying from a blow to the heart, but it's good to know the facts. Glad there's only 20-40 milliseconds in which it can happen. :P

And I love your new blog look, BTW!

Phoenix said...

All I can think of now is the 5 point death punch the Bride delivers to Bill in Kill Bill. :)

Connie Keller said...

Wow, I've never heard of this before. How horrible.

Cynthia Chapman Willis said...

This is so interesting. I can understand how it would be risky using it in fiction. Maybe too convenient.

Carol Riggs said...

Yikes. My heart is feeling weird now. LOL Thanks for the intriguing info!

Catherine Stine said...

OUCH! is my first reaction. I'm not sure I'd have the guts to use this in fiction. So far, I've had one guy drowned and partially eaten by fish, which somehow seems more benign than this heart "punch". :)

Sophia Chang said...

Lydia this is the COOLEST medical monday EVER. And I'm so effin' paranoid that for some reason this scares the crap out of me, DESPITE your emphasis on how rare this is. I'm like, oh great, just by thinking this I'll somehow promote the synchronicity to allow all these factors to converge at precisely the right time.

STOP IT BRAIN!

Stephen Tremp said...

Lydia, this is an amazing coincidence. Just a couple hours ago I was reading Worth Dying For from Lee Child and there is a section where the main character, Jack Reacher, punches a gad guy over the heart (in self-defense) and the guy dies of Commotio Cordis.

Child writes a similar description that you wrote including the sports analogies. He did mention the bad huy's heart rate increased three-fold so this heightened the chances of the event being able to happen.

i'm glad I stopped by today!

 
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