It can happen in 1/64 of a second. A fastball, lacrosse shot, or wayward elbow to the chest can be deadly. While injuries on the field and in the athletic arena are common, no one anticipates that a young athlete will die of a mysterious but all-too-common syndrome called commotio cordis, a rare disruption of the heart's electrical system resulting from a blunt impact to the chest that leads to cardiac arrest.
The syndrome is a poorly recognized and underreported event that happens to healthy young athletes as a result of a low-energy, non-penetrating blow to the chest. Commotio cordis does not result solely from the force of a blow. It is largely the result of the exquisite timing of the blow during a narrow window within the repolarization phase of the cardiac cycle, 15 to 30 milliseconds prior to the peak of what is called the heart's T-wave.
Young athletes, such as 14-year-old Louis Acompora, who died while playing lacrosse for his high school, are especially at risk because of the pliability of their chest walls.
Time is a critical factor after the onset of the event. Early defibrillation is essential.
To prevent deaths from commotio cordis, it is necessary to train coaches, bystanders and other sports personnel in the recognition of this event. Access to automated external defibrillators (AEDs) within minutes is crucial to achieve this goal.
Equipping schools with AEDs is central to the mission of Neighborhood Heart Watch, which is spearheading the Keep the Beat campaign with AED maker Medtronic, to save lives with early defibrillation. To learn more, log on to www.neighborhood-heart-watch.org.
Promising Treatment For Blocked Leg Arteries
In March, a landmark clinical trial evaluating a drug-coated stent for peripheral arterial disease (PAD) received its first patient. The disease, which affects more than 10 million Americans each year, often goes undiagnosed, according to the American Heart Association.
PAD affects blood vessels that lead from the heart to other areas of the body, such as the legs, feet, and kidneys. When blood vessels become blocked due to fatty deposit buildup, blood circulation becomes restricted. Untreated, PAD can lead to pain when walking and potential gangrene and amputation.
The trial at Stanford University Medical Center is the first in the U.S. to test whether drug-eluting stents, which have demonstrated positive benefits in treating patients with coronary artery disease (CAD), could offer similar benefits in treating arteries outside the heart. The stent is a small metal device that acts like a scaffold to help prop open blocked arteries. All too often, however, arteries become blocked again as scar tissue forms around the implanted stent. To prevent return of blockage, the stent is coated with paclitaxel to potentially reduce the risk of renarrowing of the artery.
"We already know the benefits of drug-coated stents for the treatment of coronary artery disease," said Michael Dake, M.D., the principal investigator of the multicenter study. "We're hoping to translate that success to the peripheral circulation, especially in the legs, where blockages can be disabling."
Researchers plan to enroll 60 patients in the pilot study, which is being conducted in 10 U.S. medical facilities. Recruitment is expected to be complete by the end of 2005; an expanded trial is planned pending FDA review of initial results.
The stent was made by Cook, Inc., a large medical-device manufacturer that is sponsoring the clinical trial.
Eligible participants who have crampy calf pain after walking, relieved by rest, will be tested to see if they have a blockage in the superficial femoral artery--the most common cause of such pain and the target of this clinical trial. Those interested in participating can learn more about enrollment by contacting the research coordinators of Stanford's Division of Interventional Radiology at 650-725-9810.
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