How an NFL hit like Damar Hamlin's can stop a heart

How an NFL hit like Damar Hamlin’s can stop a heart

Buffalo Bills safety Damar Hamlin suffered a cardiac arrest after getting hit on Monday night during an NFL game against the Cincinnati Bengals. The play looked routine for a professional football game.

Bengals wide receiver Tee Higgins caught a pass while cutting across the field at full speed. He lowered his shoulders to prepare for Hamlin’s tackle, a bearhug that caught Higgins’ shoulder pads directly in the chest. The whistle blew. Both players hopped up. But after a beat, Hamlin collapsed on the field.

As of Tuesday afternoon, Hamlin remained in critical condition and intensive care after suffering a cardiac arrest, according to a statement released by the Buffalo Bills. The incident raises questions about how the physics of a hard hit could stop a heartbeat on a biological level.

A handful of medical conditions might explain what happened, but two cardiologists who watched replays of the hit said Hamlin may have experienced commotio cordis, an uncommon medical event where blunt force to the chest knocks the heart off its normal rhythm.

“I wasn’t involved with his [Hamlin’s] care, however actually, I’ve seen previously very not often a situation often called commotio cordis,” mentioned Dr. Deepak Bhatt, a director of Mount Sinai Heart, the cardiovascular drugs middle of the Mount Sinai Well being System in New York Metropolis. “All of a sudden that can precipitate a cardiac arrest.”

Commotio cordis principally occurs in youngsters, throughout youth sports activities like baseball or hockey as a result of it normally happens when a small, onerous object hits the chest at simply the appropriate angle and simply the appropriate time. That makes the situation very uncommon.

A broadly cited medical evaluation printed by Tufts College in 2012 said that about 10 to twenty instances had been reported yearly to a nationwide registry. The evaluation states that revival after commotio cordis solely occurs in about a third of instances. Such resuscitation depends on utilizing a defibrillator to shock the heart again into its applicable rhythm.

However the situation stands out within the realm of cardiac arrest as a result of it can occur with none lasting bodily harm to the heart.

“It’s not that it’s damaging the heart at all,” mentioned Dr. Laurence Epstein, a heart specialist with Northwell Well being in Nassau County. “Usually, it’s purely an electrical phenomenon.”

An ideal storm of dangerous timing and simply the correct quantity of drive

As Epstein defined, the heart is a muscle, and like any muscle in your physique, it makes use of electrical impulses to stimulate the heart cells to contract. These electrical pulses occur in and unfold via three key components of the heart in a exact sequence. This fine-tuned sequence makes up what we all know as a heartbeat — the place the muscle cells contract and reset (loosen up) again and again.

Throughout commotio cordis, a blunt affect primarily interrupts the sequence simply because the heart muscle cells are resetting their electrical exercise — or repolarizing. The result’s ventricular fibrillation, the place the decrease heart chambers begin contracting erratically creating a disrupted rhythm. Blood stops pumping via the heart and lungs and can’t decide up very important oxygen earlier than being launched again to the remainder of the physique.

“The heart is just kind of wiggling and not pumping any blood,” Epstein mentioned. “So there’s no oxygenated blood going to the brain.”

All of that’s in distinction to a cardiac or myocardial contusion — the place blunt drive traverses via the chest cavity and bruises the heart — or worse. Although the blow doesn’t penetrate the pores and skin, such an affect can harm heart valves or rupture the muscle tissue that makes up the organ.

Epstein mentioned underlying situations — like genetic issues — can additionally weaken the heart muscular tissues, making them extra susceptible to arrest after blunt drive trauma. On Twitter, misinformation started circulating quickly after Hamlin’s incident, suggesting that COVID-19 vaccines would possibly someway be concerned. Related misinfo circulated after Danish soccer participant Christian Eriksen skilled cardiac arrest throughout a match in 2021, though he had reportedly not acquired COVID-19 vaccines on the time.

“From a scientific perspective, [this misinformation] is just idiotic,” Epstein mentioned. “It is using a tragedy to further one’s political causes, and it’s really offensive.”

Damar Hamlin of the Buffalo Bills tackles Tee Higgins of the Cincinnati Bengals during the first quarter of a game at Paycor Stadium in Cincinnati, Ohio, Jan. 2, 2023. Hamlin was taken off the field by medical personnel following the play.

Dylan Buell/Getty Images

Research on commotio cordis, mentioned in the Tufts medical review, found that a ball moving at high speed would need to hit the chest within a very short window during a heartbeat sequence — only 40 milliseconds long — to cause the condition.

The ball also needed to be traveling at a certain speed: 40-mile-per-hour impacts caused ventricular fibrillation 50% of the time while 30-mile-per-hour balls triggered it 30% of the time. (These studies involved pigs, which are often used as stand-ins for humans in cardiac research given similarities in heart physiology.)

Some doctors posit that kids and teens are more vulnerable to commotio cordis because of thinner chest walls. There’s literally less space for force to travel between the point of contact and the heart.

That makes the 24-year-old Hamlin’s case unexpected. His chest just happened to get hit with the precise amount of force at the wrong time. Prior to being drafted, Higgins was clocked sprinting 40 yards in 4.43 seconds — or about 18 miles per hour at full speed. But everything from the wide receiver’s weight to the angle of his pads upon impact with Hamlin likely played a role.

“Too weak of a blow or too hard of a blow won’t cause it,” Epstein said, adding that there’s some debate in youth sports about whether too much padding in the chest area could make kids more susceptible to commotio cordis.

CPR and defibrillators can mean the difference between life and death

After Hamlin collapsed, he reportedly received CPR on the field and treatment from an automated external defibrillator, or AED, a machine that can assess a person’s heart rhythm and shock it back to normal.

Bhatt said CPR is crucial immediately after cardiac arrest. Those chest compressions make the heart pump blood and the oxygen it carries through the body.

“Importantly, blood isn’t getting from the heart to the brain [during cardiac arrest],” Bhatt mentioned. “That’s why consciousness has been lost. That’s why the person passed out.” After a jiffy of this interruption, mind harm can be irreparable and in the end result in dying.

However regardless of being resuscitated, the Payments said that Hamlin was reportedly sedated upon arrival, and his advertising rep, Jordon Rooney, said Hamlin was given a breathing tube, which is known as intubation.

Each Epstein and Bhatt mentioned intubation, when a affected person is linked to a ventilator, is regular after the heart forcefully stops.

“Virtually, everyone after a cardiac arrest would get intubated,” Bhatt mentioned.

In 2020, Damar Hamlin started a community charity, and after suffering cardiac arrest during a game this week, it received an outpouring of donations and support.

Megan Briggs/Getty Images

It is also routine to put the patient in a coma. The brain consumes a lot of oxygen, so the interruption of blood flow during cardiac arrest can really stress it out. Epstein said brain cells can start dying and inflammation occurs during this period of stress, so one countermeasure centers around inducing a coma. He added that doctors will sometimes cool the body to lower this physical stress and allay the chances of brain injury, too.

“By putting somebody in a coma, you decrease the metabolic demands of the brain… You’re hoping to limit the amount of damage,” Epstein said. “They’re probably gonna keep him intubated and sedated in a coma for a day or so before trying to wake him up to see how much brain injury there is.”

But both doctors said the incident speaks to the importance of people learning CPR and expanding access to AED machines, especially at sporting events.

“Using an AED is easy, even if you’ve never seen one before. The machine is pretty smart,” Bhatt said. “You don’t need to be a cardiologist. You don’t need to be a doctor. The device does the work.”

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