Commotio Cordis in a Professional Soccer Player
Value of MRI in Unraveling Myocardial Damage
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A 35-year-old male premier league soccer player was admitted to the intensive coronary care unit after aborted cardiac sudden death. A routine echocardiogram performed 2 years earlier was entirely normal.
The player was struck along the left anterior chest wall by a direct blow from a soccer ball during a practice game. He reported a prodrome of dizziness for several minutes before collapsing on the field. An emergency medical team documented monomorphic ventricular tachycardia, which rapidly deteriorated to ventricular fibrillation. Four electric shocks were delivered with the restoration of sinus rhythm and immediate full neurological recovery.
Initial workup revealed elevated high-sensitivity cardiac troponin T of 283 ng/L (normal range, 0–14 ng/L) and creatine kinase levels of 12 480 U/L (normal range, 20–200 U/L). The 12-lead ECG showed biphasic T waves in the precordial leads, with a normal QTc interval. Transthoracic echocardiography revealed mild biventricular dysfunction (Movie I in the Data Supplement). Coronary angiography showed normal coronary arteries (Movie II in the Data Supplement). Cardiac magnetic resonance (CMR) study with a 3T scanner (Ingenia, Philips Medical Systems, Best, The Netherlands) was performed on day 4 after …