Commotio cordis: size matters, so does shape.
Commotio cordis: size matters, so does shape.
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Commotio cordis：尺寸很重要，形状也很重要。
DOI：
10.1016/j.hrthm.2011.06.003
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发表时间：
2011
期刊：
影响因子：
5.5
通讯作者：
Ideker,Raymond
中科院分区：
文献类型：
--
作者：
Osorio,Jose;Ideker,Raymond
年轻运动员的心源性猝死是一种破坏性事件，通常由未被识别的心血管疾病引起。[1]然而，在年轻、健康的运动员身上，如果没有任何心脏病，在复极的脆弱期受到胸部撞击，就会诱发心室颤动（VF），也就是心震荡（commotio cordis）。这种现象被称为机电耦合，并通过拉伸激活离子通道介导。[2] 1920年，Schott描述了用拳头猛击胸骨下半部分如何使患有Stokes-Adams综合征的人的心脏停搏。[3] 1930年，Hyman [4]观察到，将针头插入心肌（在心搏停止期间输送药物）本身就能够使心脏去极化。这些可能是机电耦合的第一批报告。这种现象现在在不同的设置中有很好的描述，具有广泛的外部施加的机械力。1976年，Zoll等人开发了一种使用电动吻合器的体外机械心脏刺激器。通过将该装置应用于胸部的不同区域来触发心房和室性早搏。最近，据报道，胸外按压可以电刺激动物模型6以及在医院外CPR期间的人类的心脏，7，8这可能触发VF。心脏震荡是美国青年运动员死亡的第二大原因，已被广泛研究。[9]在动物模型中已经很好地描述了心动周期中胸部撞击的速度和时机在VF产生中的重要性。10因此，现在广泛接受的是，外部施加的机械力，如果足够强，可以电刺激心脏，如果足够强，定时到复极的脆弱期，并直接瞄准心前区，可以引起VF。
Sudden cardiac death in young athletes is a devastating event that is typically caused by unrecognized cardiovascular diseases. 1 However, it can also happen in young, healthy athletes who are free of any form of heart disease when a blow to the chest occurs during the vulnerable period of repolarization and ventricular fibrillation (VF) is induced, that is, commotio cordis.It has long been known that externally applied mechanical forces can stimulate the heart electrically. The phenomenon is called mechanoelectrical coupling and is mediated by stretch-activated ion channels. 2 In 1920, Schott described how a sharp impact with a fist to the lower half of the sternum could pace the asystolic heart of individuals with Stokes-Adams syndrome. 3 In 1930, Hyman 4 observed that the insertion of a needle into the myocardium (to deliver drugs during asystole) was by itself capable of depolarizing the heart. These are probably some of the first reports of mechanoelectrical coupling. The phenomenon is now well described in different settings with a wide range of externally applied mechanical forces. In 1976, Zoll et al 5 developed an external mechanical cardiac stimulator using an electrically powered stapling gun. Atrial and ventricular premature contractions were triggered by applying the device to different areas of the chest. More recently, it has been reported that chest compressions can electrically stimulate the heart in an animal model 6 as well as in humans during out-of-hospital CPR, 7, 8 which may trigger VF. Commotio cordis is the second leading cause of death in youth athletes in the United States 1 and has been extensively studied. 9 The importance of the velocity and of the timing of blows to the chest during the cardiac cycle in the generation of VF has been well described in an animal model. 10 Therefore, it is now widely accepted that an externally applied mechanical force, if sufficiently strong, can electrically stimulate the heart and, if sufficiently strong, timed to the vulnerable period of repolarization, and aimed directly at the precordial area, can cause VF.