J波综合征严干新概要.ppt

* * Figure 3. Stop-Frame Images of a Fatal Commotio Cordis Event in a 14-Year-Old-Boy during a Karate Match in Which the Unprotected Precordium Represented a Prescribed Scoring Target. Panel A shows the fatal blow to the chest just before impact. Panel B shows the blow striking the left side of the boys chest over his heart. Within a few seconds (after taking several steps), the boy falls to his knees (Panel C), presumably because of ventricular tachyarrhythmia, and then collapses (Panel D). Cardiopulmonary resuscitation was unsuccessful. Film provided by Cathy Hasipas. Commotio cordis: sudden death due to chest wall impact in sports Sudden death resulting from relatively minor chest wall blows (commotio cordis) has been described in the medical literature since the late 1970s.1 Since this phenomenon was first described, 70?cases have been collected (Barry J Maron, personal communication, 1998). This number is, in all likelihood, an underestimate of the true incidence of this phenomenon as many cases go unreported or are reported as accidental deaths or idiopathic sudden death. Indeed, a case of ventricular fibrillation during a soccer match, although initially reported as idiopathic, was on careful review of the events, discovered to occur after an elbow blow to the anterior left chest2 (Gianfranco Buja, personal communication, 1998). Commotio cordis occurs most frequently in baseball, but sudden death owing to chest impact has also been reported in hockey, lacrosse, softball, and after bodily impacts in other sports.1-6 There are no known cases in cricket, but given that the ball is quite similar in size, weight, and hardness to a baseball, cricket players may also be at risk for commotio cordis. The lack of deaths resulting from chest wall impact in cricket matches is likely because of the lower numbers of individuals playing the game (compared to baseball) and to the frequency of batsmen wearing protective chest gear. However, it is also possible that deaths re