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.
- 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.
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. :)
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