Hace unos días un jugador de la NFL (fútbol americano), del equipo Bills de Buffalo, Damar Hamlin, de 24 años, sufrió un fuerte traumatismo en su pecho, colapsando, perdiendo el conocimiento e ingresando en «estado crítico», evolucionando con mejoría dentro de su gravedad. ¿Qué es lo que tuvo? A esta entidad se le conoce médicamente con el nombre de «COMMOTIO CORDIS».
La commotio cordis (CC) es un traumatismo cerrado no penetrante en el tórax que produce un ritmo cardíaco irregular y, a menudo, conduce a la muerte súbita. No se suele apreciar daño estructural en el tejido miocárdico en la autopsia, y las víctimas habitualmente son jóvenes y, por lo demás, sanas. La fibrilación ventricular es la arritmia más común y la desfibrilación temprana mejora las tasas de supervivencia, tal y como sucedió en el caso del joven jugador de los Bills de Buffalo.
Hay muchos factores que juegan un papel esencial en la CC: el momento, la ubicación del golpe y la velocidad. El mecanismo subyacente que ocasiona la CC es un aumento de la presión ventricular que conduce a la activación de los canales de estiramiento. Aunque el colapso cardiovascular es prácticamente instantáneo, el 20% de las víctimas permanecen físicamente activas durante unos segundos después del golpe, (p. ej., continúan caminando, corriendo, patinando, lanzando una pelota o incluso hablando), lo que puede reflejar la tolerancia individual a las taquiarritmias ventriculares sostenidas.
La CC ya fue descrita en 1763, aunque analizada por 1ª vez en 1932. Se indica que aproximadamente el 20% de los casos de muerte súbita informados en atletas jóvenes norteamericanos se atribuye a CC, solo superado por la miocardiopatía hipertrófica, y la mitad de CC ocurren durante deportes competitivos (béisbol, hockey, softbol, fútbol americano, artes marciales,…). El 25% de los casos informados de CC en el béisbol juvenil fueron tras un lanzamiento de pelota que promediaba una velocidad de 50 a 80 km/h.
La fibrilación ventricular (FV) es el ritmo inicial más común en CC y se produce tras un impacto precordial durante una parte vulnerable de la pendiente ascendente de la repolarización de la onda T (10-30 ms antes del pico de la onda T), y el centro del ventrículo izquierdo es el zona más vulnerable.
El inicio inmediato de la reanimación cardiopulmonar y del protocolo de desfibrilador externo automático es primordial durante un evento de CC presenciado aunque, en ocasiones, no tiene éxito. En solo alrededor del 25% de los casos informados en el registro de Minneapolis, la reanimación cardiopulmonar o la desfibrilación dieron como resultado la supervivencia, un porcentaje bajo, considerando que la commotio cordis se define por la ausencia de enfermedad cardíaca estructural. Hay una serie de casos que demostró que el 71 % (15 de 21) lograron una recuperación física completa y el 29 % (6 de 21) tenían una discapacidad neurológica residual de leve a moderada o insuficiencia cardíaca en el seguimiento (manifestada por una fracción de eyección del ventrículo izquierdo reducida). Por lo general, no se recomiendan las pruebas electrofisiológicas ni el desfibrilador cardioversor implantable. Las decisiones de volver a jugar deben tomarse caso por caso.
Confiamos en la rápida y buena recuperación del jugador de fútbol de los Bills de Buffalo.
REFERENCIAS
Palacio LE, Link MS. Commotio cordis. Sports Health. 2009 Mar;1(2):174-9. doi: 10.1177/1941738108330972. PMID: 23015869; PMCID: PMC3445066.
Barry J. Maron, N.A. Mark Estes, III. Commotio cordis. 2010 March. N Engl J Med 2010; 362:917-927 DOI:10.1056/NEJMra0910111
Tsang DC, Link MS. Sudden Cardiac Death in Athletes. Tex Heart Inst J. 2021 Sep 1;48(4):e207513. doi: 10.14503/THIJ-20-7513. PMID: 34669953; PMCID: PMC8717749.
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