So don’t think I am going to give you a startling ride and you need the seat belt, but…wear your seat belt.
There has been much “commotion” about commotio Cordis… That is where the heart fibrillates after being struck with a blow. Even a YouTube video of where on the “T” wave the strike needs to occur. Actually this is very sophomoric interpretation. Indeed - look at an EKG tracing and you can see the P, Q R, S, T waves.. the T wave is during the depolarization part of the cardiac cycle. Any electrical stimulus during that time can be dangerous and set the ventricle into fibrillation. What about electrical? The breast bone acts almost as a piezo electric crystal.. you know that thing that goes click, or pop on your outdoor cooker or even a small butane lighter. That physical structural change associated with a strike, results in an electric current strong enough to cause a spark, strong enough to then light a butane or propane gas flow. The strange thing is - the sternum sort of acts like a crystal and electrical current occurs when the sternum is struck. We Think. Saying that… yes - I have used the technique in the ICU. Once while “rounding” in the ICU I was seeing a patient at the bedside and before our eyes, he suddenly fibrillated and passed out. I hollered for the crash cart with the defibrillator, but in my boldness folded my right hand into a fist (he was unconscious anyway) and struck him in the middle of his sternum. He immediately came back into sinus rhythm and he didn’t have to “ride the lightning” as we used to say. He did well.. except the next day he did say to me… “DOC, you swing a pretty mean right hook!” I said “sorry” and he said, no - I needed it. Point is, it was lucky but hey, if someone goes down near you and there is no defibrillator around, if they are dying and it doesn’t work, then well.. you know. The problem is that if a person has a normal EKG rhythm and that stimulus occurs at the right time on the T wave, ventricular fibrillation can be stimulated and that is often a terminal event. Unless shocked back into normal rhythm. Now think about steering wheel in cars.. If you are not wearing a seat belt and you fly forward and hit the middle of the steering wheel, it could cause ventricular fibrillation. Even worse - if you are not even going that fast, not wearing your seat belt driving down a rocky country road, and you go over the curb and through a fence, you may slide forward into contact with the steering wheel and then your bumper hits the oak tree on the other side and the “air bag” deploys, it may rupture your heart mechanically as well as the electrical issue above. WEAR YOUR SEAT BELT!—- always. One mechanical engineer who became a doctor and was a friend of mine in the USAFR.. taught me that the explosive charge in the air bag is the same at four inches away as a 12 gauge shotgun! So WEAR YOUR SEAT BELT.
Additionally, I had a patient once who came in, and was a young 30 year old Canadian pilot who had suffered a car accident when in his late teens and did have a contact with the center of the steering wheel and thought nothing of it. He saw us on the vascular service because of a sudden pulseless, painful leg and we did an emergency femoral artery exploration. We found an old clot, pulled it out, restored circulation and the leg— did fine. Being concerned, we then studied him with angiograms finding he had several places that clots had gone several other places and not caused much of a problem due to collateral circulation. Eventually (these were the old days. in the 70s) we did a ventricular angiogram and found he had a left ventricular aneurysm full of clots. He was shedding those and they were going around in his circulation causing mayhem. Fortunately none to the brain! So we then put him on the heart lung machine, did a ventricular aneurysm resection and repaired the heart. He did well after that. Point again being WEAR YOUR SEAT BELT!
Now as to the recent football player episode. I saw the video and did not see a terrible aggressive blow to the chest. There was certainly no spiking with the helmet into the numbers. So I actually am not very impressed with commotio Cordis diagnosis. What else could it be? Actually some athletes have a very strong large heart and the outflow tract of the ventricle can impede the flow out of heart into the ascending aorta. Yes, it is more common in African-Americans, but not so much in Football players. Usually occurs for some reason in very tall Basketball players. The fancy name is idiopathic hypertrophic sub aortic stenosis. Treatment is initially with beta blockers but may include surgery where we cut out a “trench” into the left ventricular muscle on the septal side to allow blood to get into the aorta easier. So - that is a possibility. That is why one usually sees automatic external defibrillators (AEDs) around basketball courts. But nine minutes away in a football stadium is insane. No way that will save anyone. Hint.. Ask your school board how many AEDs are in the basket ball and football areas? And if not why not. More on this in a later substack.
If he expires and an autopsy is allowed, it will tell us about IHSS vs cardiomyopathy which is an inflammation of the surface of the heart in COVID patients after a shot. I do NOT know what his VAXX status was but apparently the team required the shot in all players.
The most common explanation these days with deaths in young athletes occurring constantly around the world - in COVID injected folks.. is that the injection was responsible, myocarditis likely followed and a sudden ventricular arrhythmia occurred..whether there was a sharp blow or not. Watching the TV pictures of athletes toppling over (without a chest blow) gives one the suddenness of this disaster.
A superb write up by Dr Malone summarizes things.
Also, Dr Peter McCullough weighs in on this issue. Being a Dallas cardiologist, he likely has seen more than I have. But realize.. before COVID shots this was a very very unusual event and we are seeing these arrest around the world by the thousands.
But, even though I have not “treated” thousands I still say WEAR YOUR SEATBELT. Because of above and yes, this is also gonna be a bumpy ride when we eventually get into court with these mandatory injections that have proven lethal in some folks, actually thousands and thousands of folks worldwide.
So comments or condemnation.. bring on the replies. Cause we are “playing” on my side of the court now.
Thank you!!
Thank you!!