Commotio cordis: clinical implications of blunt cardiac trauma.

Blunt cardiac trauma can result not only in major structural impairments but also in subtle derangements without an apparent organic defect. Cardiac dysrhythmias, including ventricular fibrillation and sudden cardiac arrest, can occur in both cardiac contusion and cardiac concussion (commotio cordis) and may be fatal. The true incidence of these nonstructural cardiac injuries is unknown. Continuous electrocardiographic monitoring, assessment of cardiac troponin I and transesophageal echocardiograms are important aids in the evaluation of cardiac contusion and concussion.