Damar Hamlin may have suffered a $200million heart injury that cut off blood supply to his brain and triggered cardiac arrest, doctors say.
The 24-year-old Buffalo Bills safety collapsed during Monday night’s game against the Cincinnati Benegals and was resuscitated on the field.
This morning, the Bills revealed Hamlin had gone into cardiac arrest and his heartbeat had been restored on the field. He was taken to the hospital where he is in critical condition.
Doctors believe the blow to the Buffalo Bills star’s chest disrupted his heart’s pumping mechanism, disrupted blood flow around his body and shut down his brain in what is known as ventricular fibrillation.
But to make matters worse, experts speculate that this may have happened during a very vulnerable moment in the heart’s electrical cycle, triggering a condition known as “commotio cordis.”
This occurs when something makes contact with the chest wall just as the lower chambers of the heart are refilling with blood. The impact then causes the rapid and disorganized contraction of the lower chambers of the heart, disrupting the normal pumping of blood throughout the body.
This window is only 20 milliseconds long, making commotio cordis incredibly rare. Globally, only 30 people suffer the injury each year, and only about 200 cases have been reported among Americans. It has previously been observed in young baseball or hockey players receiving a hit from a baseball or hockey puck in the center of their chest.
Hamlin collapsed shortly after collapsing, falling backwards and lying motionless on the floor
The critical question, doctors say, is how long Hamlin’s brain went without the oxygen carried to the organs by blood flow.
Brain tissue quickly dies when deprived of oxygen, which can result in permanent injury.
But there is hope for Hamlin. About nine out of ten people who suffer cardiac arrest outside of the hospital die.
But CPR can help improve those odds. CPR can double or triple a person’s chances of survival if performed in the first few minutes of cardiac arrest.
Survival rates drop to three percent if resuscitation is delayed more than three minutes, doctors say.
dr Bernard Ashby (left), a vascular cardiologist, said the player likely suffered a ‘commotio cordis’ – when a sudden blow to the chest causes cardiac arrest. dr Chris Haddock, a general practitioner in Georgia, agreed with the diagnosis
The graphic above, from a medical journal, shows what happens when someone suffers from commotio cordis, which many doctors believe is what Damar Hamlin may have suffered
dr Deepak Bhatt, a top cardiologist at Mount Sinai Heart in New York City, told that Damar Hamlin likely suffered from commotio cordis.
“The first thought that came to me was that it was something called a commotio cordis,” he said.
“It really relates to the classic chest injury.
“This is usually what happens in baseball when someone slams a line into the pitcher’s chest and that sudden impact can trigger abnormal heart rhythms.
“The only way to get out of this is to administer an electric shock and perform CPR.”
When asked why the player was able to get up shortly afterwards, he said: “It may be that enough blood has entered the brain for a few seconds.
“When the heart stops beating, we lose consciousness within seconds. Those were maybe the few seconds before the brain stopped getting enough blood.”
dr Bhatt said it would be 24 to 48 hours before doctors could say how the player is doing after completing a series of tests.
“People can be cold for so long, and heart and brain function can take a good 24 to 48 hours to recover,” he said.
In the best-case scenario, patients could stay in the hospital for at least a week to 10 days, he said. In worse cases, this will take longer.
When asked if the player could return to the pitch in the coming months, Dr. Bhatt didn’t rule that out, but said it was a “much, much more complex question”.
‘[Assuming minimal damage to the player], [doctors] would want to do a lot of testing,” he said.
“This would involve some sort of stress test on a treadmill, with exercises under surveillance conditions to make sure the same thing doesn’t happen again.
“It wouldn’t be unexpected to do a stress test as well, pushing them to the limit and just making sure nothing bad happens.”
dr Anthony Cordillo, an emergency medicine expert in Los Angeles, California, said the player may have suffered ventricular arthymia
dr Bernard Ashby, a vascular cardiologist who previously worked at Columbia University Medical Center in New York City, said: “Damar Hamlin’s video, as seen by a cardiologist, resembled a commotio cordis — a phenomenon that occurs when a sudden blunt impact occurs on the chest heart causes arrest.
“Timely defibrillation is life-saving and prevents anoxic brain injuries. I pray an AED was nearby.”
dr Chris Haddock, a primary care physician at Georgia’s Erlanger Health System, concurred with the diagnosis.
He wrote on Twitter: “As a doctor, I believe Damar Hamlin probably suffered from commotio cordis, where a blow to the chest stops the heart at a precise moment in the electrical cycle.”
He added: “Those trying to tie this to vaccine status to project their unscientific beliefs are terrible, terrible people.”
dr Anthony Cordillo, an emergency medicine expert in Los Angeles, California, suggested to ABC7 that the player suffered from a ventricular arrhythmia.
He told the broadcaster: “This is a phenomenon that occurs when the heart alternates between its beats, when that heart depolarizes and then repolarizes, when you have traumatic trauma in the chest at a very specific moment, while that heart is repolarizing itself You can get into a fatal ventricular arrhythmia.
“And that looks like it happened because he was able to get up and at that point his heart started what we call fibrillation, which is this cardiac arrest where he collapsed back down.
“And they would have recognized the strange pulse at that point.”
He ruled out an injury in which the aorta – a large blood vessel – was severed because people suffering from such an injury don’t get back up.
Other doctors have suggested that the violent contact may have ruptured a bulge in a blood vessel — medically called an aneurysm.
It could have been combined with a previously undetected heart defect, among other things, to trigger a life-threatening event, they added.
WHAT IS COMMOTIO CORDIS?
Commotio cordis is when a sudden blunt impact to the chest causes sudden death with no damage to the ribs, breastbone, or heart and no underlying heart problems.
Since 1995, more than 224 cases have been reported to the US Commotio Cordis registry, and the survival rate is 24 percent.
Commotio cordis is a primary arrhythmic event that occurs when the energy generated by a beat is confined to a small area of the heart – called the precordium – generally above the left ventricle.
It fundamentally changes the electrical stability of the myocardium, the muscular wall of the heart that contracts and relaxes as blood is pumped.
This leads to ventricular fibrillation, the most serious cardiac arrhythmia, in which the heart trembles instead of beating, disrupting the ability to pump blood.
Sometimes triggered by a heart attack, ventricular fibrillation causes a drop in blood pressure, cutting off blood flow to vital organs like the brain.
Commotio cordis events are most common in sports, and so the phenomenon has become better known to the sports community and physicians.
Commotio cordis primarily affects young men, with an average age of 15.
Chest wall stiffening is thought to contribute to the decrease in incidence in older people, possibly because not many older people play ball-related sports.