Medical News

Athletes are more prone to sudden cardiac death and arrhythmias than nonathletes. Sudden cardiac death in athletes is rare in the absence of heart disease, with the exception of commotio cordis. It is common enough amongst athletes that commotio cordis should be suspected if an athlete collapses suddenly after a chest impact and is unresponsive. So what is commotio cordis?

The heart is driven by the movement of electrolytes across the cardiac cell membranes. That movement is controlled in part by electrical signals, in part by pressure differences, and in part by small channels in the cell membranes that open and close, called ion channels. This complex dance can be measured by watching the electrical impulses that are caused by the movement of those electrolytes. That organized movement of charges causes organized muscle contraction, causing the heart to pump blood. It looks like this:

In the above diagram, note that each peak is labeled, and each of the small squares in the horizontal plane represents 40 milliseconds. You will note that the normal cardiac cycle lasts about 360 milliseconds in our example.

An impact to the area of the chest that includes the cardiac silhouette during the 10 to 30 milliseconds before the highest peak of the T wave that causes a pressure wave to wash over the heart, if that pressure wave is between 4.8 and 9.6 psi, can stretch some of those ion channels to the point where some will open when they are not supposed to. (Mostly the K⁺atp channels) That in turn causes some electrolytes to move, creating random movement of electrical charges. It changes a heart rhythm from the organized one we are all familiar with to the one below:

In order for this to happen, the impact has to occur within a narrow timeframe (20 ms wide out of 360 ms total) and within a narrow pressure range. Too low, and nothing happens, too high and you get a cardiac contusion and tissue damage.

With these rather strict parameters, the phenomenon still manages to happen about 20 times per year in the US, usually with fatal results. It’s mechanism is well documented and mostly understood. More than 90 percent of the time, the victims are men. More than 85% of the time, the victims are between the ages of 13 and 20. This is mostly because the vast majority of people who participate in contact sports are males between 13 and 20 years old.

There is a genetic correlation. People with known long QT syndrome in their family history are known to be more susceptible to this- for example, Brugada syndrome. We all have heard of athletes periodically dropping dead during and after practice. It’s one of the reasons why high school and college athletic facilities are equipped with AEDs and why some states require that athletes be screened for long QT before they can compete in school sports.

Look, the vax is certainly causing some unexplained deaths. If you want to be convincing, you have to be able to tell the difference between what is a sudden death and what is normal background. You aren’t going to convince people if you are sounding like an ill informed moron with a political axe to grind. Think of how the anti-gunners look when they start talking about “shoulder things that go up.”

Be informed. Don’t come across like a paranoid moron.

Sources for this post:

Athletes and Arrhythmias. Journal of Cardiovascular Electrophysiology. 2010

Commotio Cordis: Ventricular Fibrillation Triggered by Chest Impact–Induced Abnormalities in Repolarization. ADVANCES IN ARRHYTHMIA AND ELECTROPHYSIOLOGY, the American Heart Association. 2012

Fatalities in High School and College Football Players. The American Journal of Sports Medicine. 2013

Incidence of Sudden Cardiac Death in National Collegiate Athletic Association Athletes. Circulation, the American Heart Association, 2011.

Pathophysiology, Prevention, and Treatment of Commotio Cordis. Current Cardiology Reports. 2014

Sudden Cardiac Death in Athletes. Methodist Debakey Cardiovascular Journal. 2016

Not every person who died in 2020 died of COVID. That was ridiculous, and the claims of COVID deaths made those claiming them look stupid. Similarly, not every sudden death happening now is because of the COVID vax.

Yet I have seen many on the right this morning claiming that the collapse of Damar Hamlin was due to the jab. No, it likely wasn’t. For those who aren’t aware, an NFL football player took a hit to the chest in a game last night before collapsing in cardiac arrest.

What likely happened was a phenomenon called commotio cordis. This condition is caused by an athlete taking a blow to the chest while the heart is in its relative refractory period. The heart enters an arrythmia called “ventricular fibrillation” and the person has no pulse. The condition is usually fatal without immediate CPR, followed by immediate access to defibrillation and Advanced Cardiac Life Support. (ACLS)

A similar thing happened in the NHL to Chris Pronger, who collapsed during a 1998 hockey game after taking a blow to the chest from a hockey puck. He went into cardiac arrest. You can see a video of it here (I would embed it, but YouTube doesn’t allow this video to be embedded). Events like this are more common than you would think.

I have been watching tons of conservatives on social media being just as dogmatic as the left was about COVID on this topic. Don’t make yourself look stupid by trying to pontificate on things that you have no knowledge of, simply so you can make a political point. It weakens your argument and makes you look like a tool.

So many people are trying to use this event to springboard their agendas. I saw an NFL player on TV saying that this is why they make millions, because they are putting their lives on the line to play football and this is why the salary cap for the NFL should be raised. He is saying that most players don’t get many years to play, and the risk is high. Keep in mind that the league minimum salary is $705,000 a year, the average player salary is $2.7 million a year, and the highest paid player makes $31 million a year. When you say things like that, you make yourself look stupid.

Joe asks in comments if I have heard anything about this article referencing a “tripledemic” of RSV, COVID, and Influenza.

Respiratory syncytial virus, or RSV, is a common respiratory virus. It usually causes mild, cold-like symptoms. RSV usually strikes children before the age of 2, and is also known to have a severe effect on those over 65 and with weakened immune systems. In the United States, nearly all children have been infected with RSV by age two. This virus has a season, and in the United States, Florida and Hawaii’s season begins in mid September, with the rest of the country’s RSV season beginning by mid-November. The incidence of RSV peaks each year by mid-winter. It is an airborne virus that can also be spread by fomites.

A fomite is a surface that is contaminated because a virus that can live for a time outside of its host is on the fomite’s surface. A person touches the fomite and then touches their face. The average person touches their face 4,000 times a day. Kids even more so. This is why frequent handwashing can be effective in preventing illness.

Influenza also has a season, as we all well know. It also strikes the immunocompromised and the elderly.

Until 2020, patterns for RSV in the United States were predictable. The patterns of RSV and other common respiratory illnesses have been messed up since the lockdowns in 2020. The number of RSV infections began to rise in the spring of 2021 and peaked in July. Why? I mean, this is usually a winter virus.

In 2020 and into 2021, there weren’t many cases of seasonal illnesses because kids were largely kept out of school during the peak RSV and flu seasons during the winter of 2020-2021. In most states not named Florida, the same happened during the 2021-2022 season, so all of the kids who would have brought the virus home to their younger siblings weren’t in school to do so. That means all of the kids born in 2019, 2020, and 2021 have not been exposed to RSV and this will create a heavier than usual RSV and flu season. It makes total sense.

The same is true of the flu. This year, the season appears to be starting a bit earlier than usual, but that is not surprising, considering what I discussed above. The past couple of years have been unusually light for the flu, and I think that we are going to have a rebound year.

So what does this mean? Nothing. Most people who get it have a bit of a cold and then soon recover.

As far as COVID: granted that this is anecdotal, but we don’t seem to be seeing any more COVID than we have been seeing for the past year, at least not in my hospital. It’s just a constant background now. I have had it twice, and I don’t even bother to wear a mask when I treat COVID patients any more. The CDC is not really reporting a high number of COVID cases right now.

I don’t think that there is anything to make a big deal out of right now. That may change, but for now I don’t think it’s anything to get in a lather over.

JKB over at gunfreezone asks why medical training requires doctors to do rotations in specialties that are not their own, pointing out that engineers in one field don’t have to also do internships at a civil engineering firm, a mechanical engineering firm, a structural engineering firm, and a chemical engineering firm. He states that it looks like a complete waste of the student’s time. The reason that medicine does that is actually pretty simple, so let me give a simple explanation.

It isn’t likely that a mechanical engineer will do something that will have a direct effect on a chemical engineer’s job. That chemical engineer isn’t likely going to have an issue with avoiding the problems that a structural engineer is having. Imagine if a mechanical engineer tightened a screw a quarter turn, and this caused the hydraulic fluid to become acidic and then the building collapsed. Not so in medicine. Sure, people in medicine tend to specialize, but the human body is a complex system, and changes to one system have profound effects on the others.

Let’s say that I am in cardiology and I have a heart failure patient who is in fluid overload. There are a number of drugs that one could choose from to get rid of those fluids. I could try furosemide, or perhaps bumetanide. Perhaps torsemide, or even hydrochlorothiazide. Any of those medications would likely solve your patient’s issues, but which one of these is going to be detrimental to the patient’s kidneys? Do I want to choose a potassium sparing or a potassium wasting diuretic? How will that react with the patient’s preexisting autoimmune dysfunction? I could consult a nephrologist, an endocrinologist, and an immunologist, but doctors largely don’t stand around most of the time having huge arguments. That only happens on TV shows, not because there are no egos involved, because there are. Medical people are just too pressed for time to keep doing that, so wouldn’t it be easier if I already knew?

So for that reason, most in medicine learns a little about every system and specialty before going on to gain a deep understanding of their specialty. Nurses, doctors, PAs, NPs, all of them.

The first comment on that post complains about sterile fields and how they are “superstition.” Sterile fields are there to prevent post procedure infections. You can’t see infectious agents. Perhaps you didn’t touch anything. Or maybe you bumped into something that was covered in S. aureus and didn’t notice. How do you know? Can you be sure? If you are wrong, you will know in couple of days when your patient goes septic. You can’t bet a patient’s life on “the ten second rule.” Certain behaviors are high risk, so procedures get written in to the process to reduce or eliminate those higher risk behaviors. That includes treating everything that “breaks field” as though it was covered in an infectious agent- because it might be, and there is no way to know for sure. So you toss the offending object aside, and use one that you KNOW is sterile.

As an example, the most common cause of hospital caused infections is a CAUTI (Catheter Associated Urinary Tract Infection). It’s caused by a catheter introducing a pathogen into the urinary tract. That can affect the kidneys. It can cause Acute Kidney Injury. In some cases, that can cause Chronic Kidney Disease and ultimately kidney failure, or it can cause septicemia (a blood infection), which leads to death. Because of this, there are procedures that need to be followed when inserting, caring for, and ordering indwelling catheters. Can you violate that procedure and get away with it? Sure. A few times. Maybe only once. But one thing is sure, you will eventually wind up with a septic patient. So the procedure is there to prevent that.