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

Categories: Medical News


Fido · January 4, 2023 at 12:46 am

Dr. Malone asserts that commotio cordis is *also* rare in the absence of heart disease.

Charles · January 4, 2023 at 1:02 am

The salient question here is whether or not this guy had vaccine induced myocarditis that might have induced his heart attack. I’ve read reports that everyone who’s been jabbed has at least some slight degree of cardiac inflammation. I’m wondering if that is true, or not.

My formal “medical education” ended with high school AP Biology and BSA first aid instruction. I have no authority, here. But I have been reading as widely as I possible these past two years, and it seems to me that way too many purported experts are either maliciously and systematically gaslighting us, or else are too cowardly and intimidated to tell us the truth.

I’d like to know what’s up. Is it possible that Damar Hamlin had vaccine induced myocarditis that precipitated his collapse, or not?

Joe Blow · January 4, 2023 at 5:57 am

Ok, I’ll bite.
How many teams in the league (20)?
How many active players on the team (30)?
How many games played per year (15)?

So just this year, you have 9000 players playing games per season.

How many times per game do collisions occur (??????)?
How many years has foorball been around (60+?)?
Look, my wife will not let the kids play lacross b/c when she was in HS a kid got hit in the chest with the ball and dropped dead on the spot. This Commotion corgys thing prolly killed him. One in a billion shot.

The math is what kills your argument here though, this is all springing up out of no where in a league thats been around for decades. Could it be that a 1 in a billion hit caused this poor kids death? Yes, absolutely, definitely NOT a zero-percent possibility. Occams razor forces you to ask if thats really the cause? Possible, yes. Likely? How many other athletes in non-contact sports have dropped dead like that in the middle of the game since the vaxx mandates? Seen any soccer clips? Check twitter. A far Far HUGELY greater number than those that have suffered commotion corgys on MNF. That was another incident in what is now a long line of examples (no longer can be called one offs).
TV anchors and politicians hit the floor on camera often enough its all over twitter, but this guy, this guy hit the bad luck lottery with his tackle?

Man… talk about grasping at straws?!
Ask yourself, what are the actual odds for this commotion corgy crap they’re trying to flush this down the memory hole with? 1 in a million people? 1 in a billion? How many celebs bought it last year? How many bells palsy cases spiked out of no where (Justin Beiber anyone?) There are a million signs out there pointing to the same thing, but, but, but, it _COULD_ be this, maybe.

Look, I don’t want it to be true either, as the tirtiary and quatetnary effects you have to then extrapolate are chilling to say the least, but they’re pushing this crap on kids still. How many more coincidences do you have to see before the math convinces you of the statistical certainty staring you in the face??? All cause mortality statistics through the roof so bad insurance companies are getting creamed, maybe its sudden adult death syndrome I just started hearing about? Weird how all these obscure diseases suddenly got invented or discovered and became mainstream. Have you noticed traffics not as bad as it used to be? Coinkydink, fer sherrrr….

Brutus · January 4, 2023 at 7:10 am

Here’s another source showing that myocarditis puts one at risk of this sort of thing:
Sudden cardiac death risk in contact sports increased by myocarditis: a case series

    Divemedic · January 4, 2023 at 12:37 pm

    No. Not myocardial, but fibrotic remodeling caused my myocarditis. Mild myocarditis won’t cause fibrotic remodeling.

Grumpy51 · January 4, 2023 at 8:04 am

Caveat – I have NOT fully digested this article

    Divemedic · January 4, 2023 at 12:41 pm

    I am not arguing that the mRNA vaccines don’t cause adverse events, I am saying that it isn’t likely to have caused THIS event.

Mike_C · January 4, 2023 at 10:22 am

“the normal cardiac cycle lasts about 360 milliseconds in our example.”
No, the portion of the cardiac cycle SHOWN in the diagram is about 360ms, but it’s only a part of the cardiac cycle. (I know DM knows this, but it needs to be clarified.) The cycle duration (RR interval) is dependent on heart rate. At 60 beats/minute the cycle is 1000ms, at 120 bpm, 500 ms, and so forth. Now the systolic period (when the left ventricle is squeezing) is around 300 ms regardless of the heart rate (and even in atrial fibrillation). The rest of the cycle is diastolic filling when blood enters the left ventricle in preparation for the next beat.

Another quibble: whatever happened to this football player, it’s not a “heart attack” nor is it “heart failure”. Both those are technical terms with specific meanings.
Heart attack = myocardial infarction. An MI (what we call it) is when coronary artery blood supply to the myocardium (heart muscle) is reduced or cut off completely, creating heart damage. (Elevated troponins, a chemical, and characteristic EKG changes are signs of an MI.
Heart failure = inability of the heart to adequately supply blood for the body’s needs. It doesn’t mean that the heart stopped pumping (otherwise getting shot in the head would a cause of “heart failure”).

I dunno if the vaxx contributed to Damar wossname’s death. The point is that while there is a lot of adverse events due to vaxx, it’s not clear that it was the direct cause in THIS death.

    Divemedic · January 4, 2023 at 12:47 pm

    Yes, the cardiac cycle changes in duration with heart rate. That is why we use QTc and other normalized measurements. I wasn’t intending on getting into that much depth. Most of the people reading and commenting here are having enough trouble understanding and misinterpreting what happens.

McChuck · January 4, 2023 at 11:55 am

“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.”

Let’s do the math. 20 out of 360 is 1 out of 18. That’s over 5%. So, given the “Goldilocks” chance of getting a hit at the right power level, let’s say that is also one in twenty. That would mean that at least one in every 400 chest hits would result in a death on the spot.

Doesn’t happen. There are probably that many hits in the average football game.

Doesn’t mean this one couldn’t be. Just means incredibly unlikely, when there is a much, much more likely cause.

    Divemedic · January 4, 2023 at 12:48 pm

    No. Your basic logic is flawed because you are assuming that it’s a random event. It isn’t, but it’s obvious that you determined the cause and are now working backwards from there. You have lost objectivity.

      McChuck · January 5, 2023 at 6:12 am

      So, what part of the math is wrong?

        Divemedic · January 5, 2023 at 7:52 am

        Because your analysis of the frequency of hits assumes that each hit is as likely to cause SCD as any other. (Definition of random) Then you assigned a random probability of 1:20 to arrive at your 1:400 probability. That isn’t how it works.
        Studies have been done (see the links above) that there was an average of 12 fatalities amongst football players each year from all sport related causes between 1990 and 2010. 8 of those from systemic causes like heat stroke, sickle cell trait, or congenital heart defects, and 4 from trauma (including commotio cordis, head trauma, broken necks, etc)
        Most systemic deaths occurred during practice or conditioning drills. Most trauma deaths occurred during games.
        Overall, the most common causes of fatalities were cardiac failure (41.2%), brain injury (25.5%), heat illness (15.6%), SCT (4.5%), asthma and commotio cordis (2.9% each), embolism/blood clot (2.1%), cervical fracture (1.7%), and intra-abdominal injury, infection, and lightning strikes (1.2% each).
        Cardiac failure, asthma, and infection can all be assumed to not be the case here, because of NFL medical procedures and exams.
        Looking at the film of his collapse, it was not likely brain injury, heat illness, an embolus, cervical fracture, brain injury, abdominal injury, or a lightning strike, because the symptoms of those just weren’t there.
        That leaves SCT or commotio cordis as the most likely. I would assume that the league would know if a player had SCT. So the odds of it being an undetected SCT are there, but make it far less likely than CC.
        The vax itself is causing some deaths from adverse events, and as noteworthy as that is, the odds of it being a vaccine related event are far, far lower than it being CC.
        Look, the vax doesn’t provide any positive benefit and provides some statistically significant negatives. For that reason, it should be pulled from the market. On that, I think we can agree. Those negatives, while being statistically significant in a large population, are not a large enough probability to be a factor when you consider what few facts we do have in this case.

Max · January 4, 2023 at 12:56 pm

Wow, you’re really doubling down on this. Just take the L already.

    Divemedic · January 4, 2023 at 12:59 pm

    LOL. Ok, I bow to you and your Degree from the University of Google. You should hurry up and open your cardiology practice now.
    You managed to diagnose the cause of a cardiac event from behind your keyboard 1000 miles away from the patient with no lab results, ecg, diagnostic results, or medical education.
    Congratulations, you are the Internet expert. I can’t wait until you cure cancer.

      Max · January 4, 2023 at 4:41 pm

      See? Now was that so hard?

        Divemedic · January 4, 2023 at 4:48 pm

        LOL. Smartass.

          Max · January 4, 2023 at 7:56 pm

          Sorry, couldn’t resist. Love the blog, keep up the good work

D · January 4, 2023 at 2:16 pm

> “You aren’t going to convince people if you are sounding like an ill informed moron with a political axe to grind. ”

This. So much this.

I run into a *lot* of people in a certain demographic that have “woken up” and realized they’ve been lied to about one particular thing. After they realize that, so many of them immediately revert to “everything government, religion, and scince says is a lie”.

Most of these people end up believing the earth is flat simply because NASA is both government, and science in one agency…so if they say the earth is round, it’s obviously a lie.

Of course you couple that with low-intelligence and it makes everyone else with reasonable intelligence just ignore whatever they’re saying. Even in the cases where it’s the truth.

It’s sorta like a take on the Hitler Fallacy.

If Hitler said “don’t steal, stealing is wrong”, there would be a significant number of people who would scream at you for saying “You know what…he’s right” simply because of all the horrible things he did.

Yeah, I think the vaccine is killing people. I’m not an expert in virology, nor an epidemiologist. I don’t know it for certain. But in my layman’s opinion, I believe it is.

I don’t play the card “I was an EMT over a decade ago, so I know medical shit” like some of these people do. I have a friend who regularly tells me the vaccine has “latent vectors” that will be activated by the new 5G network to turn people into mindless zombies. His proof? Links to a bunch of hour-long bitchute videos of people claiming to be doctors who say it’s so. Oh…and he was a “biomed major”. Except he was in college for 6 months back in the 80s and then dropped out. But he’ll tell you he knows what he’s talking about.

I just don’t get how people can think “everything is a lie”, but then follow it up with “…except when it’s random unverifiable shit posted to bitchute”.

/end of rant

T Town · January 4, 2023 at 2:29 pm

I read something this morning from a heart doctor who stated that it was likely not commotio cordis. His reasoning is that he was resuscitated twice (once on the field, and again at the hospital), and if it was commotio cordis, CPR should have only been needed once to restore regular heartbeat.

    Divemedic · January 4, 2023 at 3:57 pm

    If that is the case, then I would say that commotio cordis is likely not the case. See my remarks to Aesop, below.

Aesop · January 4, 2023 at 2:40 pm

And after he initially arrested, they got ROSC. Then he apparently arrested again.
So maybe he was tackled again after the code…?

This bespeaks a cardiac pathology much more serious than simply a single ill-timed football hit with lotto-level odds.

I’m keeping an open mind until more news comes out, but the percentages on this being non-vaxx induced appear to wither on the vine by the hour.

    Divemedic · January 4, 2023 at 3:59 pm

    I saw that report as well. I also saw that the rest of the family is denying that report.
    The Uncle says that there were two cardiac arrests, but the family spokesperson says there was only one, per NBC news.
    CNN is also reporting that there was only one cardiac arrest event.
    If it turns out that he arrested twice, then I would agree that commotio cordis is not the cause of the arrest.
    If he only arrested once, then I stand by what I said, unless other evidence comes out to contradict it.
    He is a young athlete in great shape. There is no evidence of other health concerns that would have caused a heart attack or heart failure. Indeed, that would be a good reason as to why an NFL team doctor would prevent him from playing.
    There is no evidence that he had any symptoms of pericarditis: chest pain, shortness of breath, leg swelling.
    There is evidence that commotio cordis in athletes happened before COVID.

    There is still no evidence to suggest that the vax caused it.
    There has to be more than:
    Something bad happened to someone.
    That someone has been vaccinated, therefore
    The vaccine was the cause.
    Come on, man. I know that you are better than that. You are on the verge of being one of the most reasonable person in a debate. You can do it, I know you can.

      Aesop · January 6, 2023 at 4:30 pm

      I’m not being unreasonable. Correlation doesn’t = causation.
      I agree with you: I want to know how many times he actually arrested, but I don’t have the Code Blue sheets, so IDK.
      But after the last couple of years, my bullshit and skepticism meters are pegged to the right stop. And we all know that none of us are getting truthful answers on the incidence of vaxx-related and vaxx-caused deaths and injuries. Since Ever. The very suggestion otherwise is risible.

      But wait and see how many more of these there are.
      I suspect it’s going to become more frequent, not a once-in-57-years event. Then what…?

      Sudden Soccer Death has become passé in Eurostan: it’s commoner than stinky Frenchmen and bad Italian drivers.
      So, arguendo, say this incident was C.C.
      Now explain all the other drop-deads.
      And the spiking total number of them.

      And ponder this: what if it turns out that another problem with the not-a-vaxxes is some pathophysiology that makes the heart far more sensitive to weak hits that never would have induced C.C. before they happened.

      Such that their incidence is off the charts.
      Just like myocarditis, pericarditis, and all the other side affects of Suddenly™.

      The whole thing becomes a difference without a distinction.

      I’d drop a spare $10 marker on that in a New York Minute.

        Divemedic · January 6, 2023 at 6:02 pm

        I agree that died suddenly is a thing, and is probably tied to the Vax. It’s just that I haven’t seen any evidence that suggests that THIS case isn’t part of the normal background of football related death.

        A single case is not statistically relevant.

Anonymous · January 4, 2023 at 8:34 pm

Another thing to think about is sudden exertional death in the presence of sickle trait. As a forensic pathologist, I have seen a number of young African-American men die suddenly during exertion. In the 1990s, it was discovered that African-Americans died at a rate 37-42 times greater than white recruits during military basic training. A similar difference in sudden death was found among football players. It has also been seen in people running from the police. Normally, this has a prodrome, but it doesn’t have to. Sickle trait is normally asymptomatic. I don’t know if this decedent’s sickle trait status has been published anywhere.

See, for instance: Mitchell, Bruce L. “Sickle cell trait and sudden death–bringing it home.” Journal of the National Medical Association 99.3 (2007): 300.

Other causes of sudden death in athletes (excluding drug-related deaths0 include anomalous coronary arteries, channelopathies, aortic dissection, hypertrophic cardiomyopathy, sarcoidosis, valvular problems, connective tissue disease, and others. In most decedents, you can find a cardiac problem.

In studies before covid, sudden death in athletes varied from 0.5 to 2.3 per 100,000 subjects per year. See: Domenico Corrado, Christian Schmied, Cristina Basso, Mats Borjesson, Maurizio Schiavon, Antonio Pelliccia, Luc Vanhees, Gaetano Thiene, Risk of sports: do we need a pre-participation screening for competitive and leisure athletes?, European Heart Journal, Volume 32, Issue 8, April 2011, Pages 934–944,

In my career, I’ve tend to see 1-2 of these deaths during exertion, per year. In all that time only one (maybe two) was/were presumed to be commotio cordis. Commotio cordis does not have anatomic diagnostic features, and is based on circumstances in the absence of competing diagnoses.

    Divemedic · January 4, 2023 at 9:12 pm

    True, but the collapse was immediately preceeded by a blow to the cardiac region. When one hears hoofbeats, you turn around and look for horses, not zebras.

      Anonymous · January 4, 2023 at 10:29 pm

      Sure. I’m not saying it’s not commotio cordis. I’m just saying that in the absence of more diagnostic information, it *could* be a number of things. My further point was that sudden death isn’t as unheard of as folk seem to think.

      The real “problem” is that the news media really doesn’t have a clue, and the docs are keeping their mouths shut, as they should. So, it’s *all* mostly speculation.

      And “the jab” is vanishingly low on the differential diagnosis list — unless it turns out he has myocarditis.

      And there are other trauma-related possibilities — such as a compression radiculopathy that had a secondary autonomic response with arrhythmia. That happened to me. I slipped and fell on a grease patch into a hard kneeling position in my garage and compressed C6. Not only did my arms go numb, but I went into atrial fibrillation and had diffuse loss of vascular tone, almost passing out. The A fib resolved spontaneously in about an hour. I suffered numbness and paresthesias along the C6 dermatome bilaterally for three days. Happily, it resolved spontaneously as well. I’d never had A fib before, and I’ve never had it since.

      People underestimate the arrhythmic effect of sudden autonomic changes.Approximately 7-11% of sudden cardiac deaths occur while people are sitting on the toilet straining at stool because of the sudden change in chest pressure associated with the Valsalva maneuver.

        Divemedic · January 5, 2023 at 8:03 am

        We call those “commode codes” and they happen a lot in retirement communities here in Florida.

Comments are closed.