GIA 2004 Excellence Winner

The Robert G. Fenley Writing Award - Basic Science Staff Writing

Tufts Medical School

When the Heart Stops Cold

The story profiles the work of Mark Link, M.D., who studies "commotio cordis," the heart stopping cold caused by low-energy chest wall impact. Commotio cordis is a little-known cause of death affecting an estimated 10 to 20 people a year in the U.S. It is generally, but not always, fatal.

Dr. Link says that the condition was thought to be so rare, until just recently, that no one had bothered to pursue its etiology. In 1996 the U.S. Consumer Product Safety Commission released a study that described 38 cases of commotio cordis from baseball blows to the chest that had occurred between 1973 and 1995. The study caught Link's eye, and he became intrigued by its implications.

Goal

• The victims are mostly kids, primarily boys playing baseball. But girls and adults also die this way, under a wide variety of conditions.
• To understand the phenomenon, Link fashioned a device that could simulate the fatal occurrence. Through experimentation, he sifted out the precise conditions that made such impacts lethal. His testing equipment replicated the human scenario of a baseball striking the chest at 30 or 40 mph, the approximate speed of most fatalities from commotio cordis.

Results

• Dr. Link's initial findings in the New England Journal of Medicine found that if the victim were struck within a tiny window of vulnerability, the heart would usually go into ventricular fibrillation (VF) leading to death.
• Dr. Link concluded that it is likely that commotio cordis is underreported nationally. Although he doubts the number runs higher than 20 per year, no one knows with any certainty how many victims there are.

Read the full narrative (Word document)

Contact: Bruce Morgan, Editor and Writer, Tufts Medicine, bruce.morgan@tufts.edu

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