Heart health lessons from the football field

February 17, 2023

Providence Heart & Vascular Team

[4 min read]

February is American Heart Month, so we’re taking some heart health lessons from the football field and applying them to how you can help save a life.
Commotio cordis is a form of cardiac arrest that occurs when a sudden, blunt impact to the chest happens at precisely the wrong time in the cardiac cycle, setting off an irregular heart rhythm and the inability of the heart to pump blood in the body. Immediate CPR and defibrillation can increase survival rates by two to three times.
The condition is rare but most commonly affects young, male athletes who play certain sports, including baseball, softball, hockey, football and lacrosse. Knowing the signs can help you take action.

Heart health lessons from the football field

Football fan or not, odds are you probably heard about what happened to Buffalo Bills player Damar Hamlin Jan. 2 during a Monday Night Football game against the Cincinnati Bengals.

The safety collapsed on the field from cardiac arrest at Paycor Stadium in Cincinnati following a tackle. As a shocked stadium looked on — and players from both teams watched in disbelief and tears — a medical team worked to resuscitate the 24-year-old before carrying him off in an ambulance. Hamlin was admitted to the hospital in critical condition. The leading explanation for what caused the cardiac arrest? Commotio cordis, which means “agitation of the heart” in Latin.

Commotio cordis is a rare phenomenon medical experts describe as a sudden, blunt impact to the chest at precisely the wrong time in the cardiac cycle, causing an electrical abnormality in the heart that sets off an irregular heart rhythm, or arrhythmia — and the inability of the heart to pump blood to the body. Without immediate CPR and a shock to reset the heart’s rhythm, commotio cordis can lead to sudden death, without any actual damage to the heart.

“In a case like this, CPR is the most critical immediate action necessary to help maintain blood flow to the vital organs,” explains Lori Tam, MD, a cardiologist for Providence Heart Clinic – St. Vincent. “The brain is especially susceptible to the lack of blood flow. When patients don’t receive early and sufficient CPR, they may not regain normal brain function, even if the other bodily organs can recover.”

Hamlin’s injury not only launched coast-to-coast support for the defensive player, but considerable interest in commotio cordis itself — what it is, how to act if it occurs and how to protect athletes from the condition.

What is commotio cordis?

A type of cardiac arrest

Each year in the United States, about 350,000 people experience sudden cardiac arrest. Cardiac arrest is an abrupt loss of heart function. It can come on suddenly or with other symptoms, and is often fatal if steps aren’t taken immediately to reverse the condition.

Commotio cordis is blunt force trauma to the chest that causes cardiac arrest.

You may hear the term cardiac arrest used interchangeably with heart attack, but while a heart attack may cause cardiac arrest, the two aren’t the same. Heart attacks are caused by a blockage that stops blood flow to the heart. [CW2]

Cardiac arrest occurs when the heart’s electrical system malfunctions and the heart stops beating properly — “arresting,” or stopping, the heart’s pumping function. The condition may be reversed if a bystander or medical expert performs CPR and applies a defibrillator to shock the heart and restore normal heart rhythm within a few minutes.

A condition affecting young athletes

Although commotio cordis is rare — with only about 10 to 20 cases reported a year — it’s critical to know the signs so you can act fast to reverse it.

Typically, commotio cordis results in someone collapsing after getting hit in the chest. They may appear fine for about five seconds after they’re struck, but once they collapse, a pulse can’t be found, and they may or may not be breathing.

It’s also important to know who may be at risk. Primarily, commotio cordis occurs in young, male athletes — and most commonly in baseball players. It’s also a risk for athletes who play softball, football, hockey and lacrosse, or any other sport where collisions commonly occur or where a solid, hard ball or puck could potentially strike a player in the chest.

What to do when commotio cordis occurs

Unfortunately, only 1 in 10 people survive cardiac arrests that happen outside the hospital — and roughly 70% of cardiac arrests occur outside the hospital, typically in the home.

While beginning CPR immediately after cardiac arrest can double or triple someone’s chance of survival, data show that bystanders only perform it 39% to 44% of the time, often because they’re a friend or family member and too shocked to take action.

As part of American Heart Month this February, the American Heart Association is hoping to educate people on the importance of taking action quickly and performing CPR and defibrillation in the event of cardiac arrest.

There are two steps the American Heart Association urges bystanders to take when cardiac arrest occurs in adults and teens: calling 911 and pushing hard and fast on the center of the person’s chest at a rate of 100 to 120 beats per minute — a skill known as hands-only CPR.

In addition to taking action to improve outcomes, there are ways to reduce the risk in young athletes, such as:

Educating them about ways to protect themselves and other players from direct hits to the chest
Making sure they’re wearing proper equipment, such as padding
Ensuring there is an automated external defibrillator (AED) located on the field that’s easy to access

USA Lacrosse recently partnered with the American Heart Association, in fact, to develop an easy-to-use, portable CPR and first aid training kit to help youth coaches learn CPR, how to use an AED and how to help during sports-related emergencies.

“What happened to Damar Hamlin illustrates the fact that cardiac arrest can happen to anyone, even someone young and healthy without a cardiac history,” Dr. Tam says. “It also shows the need for immediate CPR. Everyone should learn how to perform CPR because it can save a life.”

If you witness someone collapse, first check for a pulse, Dr. Tam says. If the person doesn’t have a pulse, start doing two minutes of chest compressions while calling, or directing someone else to call, 911.

If you don’t know CPR, consider signing up for a class. The American Red Cross and American Heart Association offer databases that list available CPR classes.

Providence Heart Institutes

The Providence health system has three award-winning Heart Institutes: Sacred Heart Medical Center in Spokane, Washington, the Providence Heart and Vascular Institute in Portland, Oregon, and Swedish Medical Center in Seattle, Washington.

These institutes serve as centers of innovation, delivering world-class health care to tens of thousands of patients each year. In addition to offering the latest advancements in diagnosis, research and treatment, the institutes give patients access to new therapies through clinical research trials, and wellness and prevention programs.

Contributing Caregiver

Cardiologist Lori Tam, MD, earned her medical degree from Oregon Health & Science University in Portland. She completed her internship and residency in internal medicine at Brigham and Women’s Hospital in Boston and a cardiology fellowship at The Johns Hopkins Hospital in Baltimore.

She is board certified in internal medicine, and her clinical interests include coronary artery disease and cardiac imaging.

Find a doctor

If you need advice on how to protect your heart and what’s best for you, talk to your doctor. You can also find a Providence cardiologist using our provider directory.

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