The Killer Impact: Understanding Chest Wall Impact Syndrome (Commotio Cordis)

January 13, 2023

Colorado Springs

(719) 309-3000

Grand Junction

(970) 287-1173


Don Cooper Ph.D.

Director of the Medical Science Division at Ramos Law

Joseph Ramos MD, JD

Principal Ramos Law

Impact to the chest causing disruption in the normal electrical activity of the heart can cause a rare but potentially fatal condition called, “commotio cordis”, also known as “chest wall impact syndrome”.  This type of injury is most seen in sports such as football, hockey, and lacrosse, but can also occur in motor vehicle accidents or any other situation where a person’s chest is subjected to a sudden impact.

There are certain factors that may increase a person’s risk of developing commotio cordis, including certain genetic conditions and medications that affect the heart’s electrical activity. Medications that may increase the risk of commotio cordis include antiarrhythmics, which are used to treat irregular heart rhythms, and certain types of antidepressants and antipsychotics. Recreational drugs such as stimulants, sedatives, and hallucinogens, as well as heavy alcohol consumption, may also increase the risk of commotio cordis by altering the heart’s electrical activity and increasing the risk of abnormal rhythms.

Recently, a possible case of commotio cordis occurred in a Monday night football game between the Buffalo Bills the Cincinnati Bengals when Damar Hamlin, a 24 year old safety for the Buffalo Bills, collapsed on the field after a routine tackle. The scene horrified players and onlookers alike: Hamlin got up from the tackle and stepped forward before falling backward, and he was then down on the field for some 10 minutes as medical staff gave him CPR and used a defibrillator to try and restore his normal heart rhythm.

While the exact cause of Hamlin’s collapse is not yet known, many of the doctors following his case believe it was likely caused by commotio cordis. This condition can affect both young, healthy males and females and has been known to occur even in people with no known risk factors or underlying heart conditions.

Can Impacts from Motor Vehicle Accidents Cause Commotio Cordis? 

In terms of motor vehicle accidents, commotio cordis is most likely to occur with a front or side impact, as these types of collisions tend to result in a direct impact to the chest. Drivers may be more at risk for this type of injury due to the proximity of the steering wheel to their chest, but passengers can also be affected if they are struck by flying debris or if the impact is severe enough.

What are the Challenges for Diagnosing, Treating and Preventing Commotio Cordis?

Diagnosing commotio cordis can be challenging, as the symptoms may initially appear to be those of a heart attack or other cardiac event. However, there are some key differences between these conditions that can help doctors distinguish between them. For example, commotio cordis typically occurs immediately following an impact to the chest, whereas a heart attack tends to have more gradual onset. Other differential diagnoses that may be confused with commotio cordis include cardiac tamponade (fluid buildup surrounding the heart), aortic dissection, and pulmonary embolism.

Treatment for commotio cordis is typically focused on supporting the person’s vital functions while their heart recovers. This may include medications to regulate the heart’s rhythm, as well as supportive care such as oxygen and fluids. In some cases, as with Damar Hamlin, a device called a defibrillator may be used to help restore normal heart function.

Preventing commotio cordis is often a matter of taking steps to minimize the risk of chest impact in high-risk activities such as sports or driving. This may include wearing protective gear such as chest pads or seat belts and being aware of the potential for impact in any given situation. It is also important for coaches, parents, and first responders to be aware of the signs and symptoms of commotio cordis so that they can take immediate action if an injury occurs.

What is the Survival Rate for Someone Diagnosed with Commotio Cordis?

Overall, commotio cordis is a rare but serious condition that can have devastating consequences for those who are affected by it. Some studies have found that the overall survival rate for commotio cordis is around 50%. By understanding the risk factors and taking steps to prevent chest impact, the incidence of this deadly condition can be reduced and ensure that those who are affected receive the best possible care. This includes being aware of the potential risks associated with certain medications and recreational drugs and taking steps to minimize or eliminate these risks wherever possible.

In addition to taking precautions to prevent chest impact, it is also important to be prepared if an injury does occur. This means knowing how to recognize the signs and symptoms of commotio cordis and taking immediate action to provide first aid and call for emergency medical assistance. By being prepared and taking appropriate action, we can work to reduce the number of fatalities and serious injuries caused by commotio cordis.

While commotio cordis is a rare and often unpredictable condition, it is still important to be aware of the risks and take steps to minimize them. By understanding the causes and symptoms of commotio cordis and taking appropriate precautions, we can work to prevent this deadly condition and ensure that those who are affected receive the best possible care. So, it is always better to be cautious and prepared for any situation rather than being sorry later.

Where Can I Get More Information about Chest Impact Injuries?

The risk of developing commotio cordis may be increased by prior chest impacts from auto accidents or sports injuries.  Repeated chest wall impacts may cause damage to underlying structure and increase vulnerability to future injury. However, the exact risk of developing commotio cordis after a prior chest impact is not well understood and would depend on the specifics of the injury and the individual’s overall health. It is important to seek medical attention if you have suffered a chest injury, as prompt treatment can help to minimize any potential complications.  If you would like to speak about the possibility of commotio cordis in a recent injury or if you are interested in the various risk factors contributing to an injury, the Medical Sciences Division at Ramos Law will help you understand the medical and legal implications and your rights to pursue a remedy. Please contact Dr. Don Cooper, Director of the Medical Science Division at Ramos Law or Dr. Joseph Ramos, MD, JD.  Our team at Ramos Law has extensive experience helping individuals with complex medical diagnoses navigate the legal and medical landscape. Complete our online form or call our personal injury law firm in Colorado and Arizona at (303) 733-6353.