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Impact Death Strikes At Heart

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By LISA A. DAVIS and GEOFF FOX, The Tampa Tribune

Published: November 3, 2007

Video: Accidental Death

They are age 13, on average. One minute they are walking, talking, swinging a bat or trying to catch a ball.

Then, suddenly, it happens.

The ball strikes them above the heart, in exactly the wrong spot. They collapse. They die.

It's called commotio cordis, Latin for "heart commotion." The blow to the chest seldom looks as though it could be so devastating.

The impact must be near the center of the heart, and there is only a 1 percent or 2 percent chance of it happening at the precise, deadly moment.

"It has to be a specific location and carefully timed in the cardiac cycle," said cardiologist Barry Maron. "You have to be unlucky."

Cayden Huels' luck must have run out Thursday night at a neighborhood park in Wesley Chapel, the doctor said. There's really no other way to explain it.

"It's an accident; a tragic accident," said Maron, of the Minneapolis Heart Institute Foundation.

Four-year-old Cayden pulled away from his 12-year-old brother while another boy hurled a baseball at a pitch-back net. At that moment, Cayden wandered in front of the net and the ball hit him in his upper left chest, above his heart.

He took a couple of steps forward and collapsed to the ground, gasping for breath.

A man in the park scooped up the motionless boy and carried him across a street to the family's home, where Cayden's mother spoke to 911 emergency operators.

When Pasco paramedics arrived, Cayden was unconscious, not breathing. He was pronounced dead a short time later at University Community Hospital in Tampa.

The boy's family was too distraught Friday to speak.

"Cayden was their world," said Charlie Van Auken, Danny Huels' boss at Ricoh Americas Corp. "I can tell you that both Danny and Sheri were dedicated parents. Their world revolves around their kids.

"They're beside themselves, and can't believe this happened," Van Auken said. "They're trying to make sense of it."

Registry Has 200 Cases

Maron didn't know Cayden. But he knows commotio cordis. He widely is considered among leading experts, collecting and analyzing information for a decade.

The U.S. Commotio Cordis Registry that Maron established lists 200 cases. He said more have happened that haven't been reported or diagnosed.

A blow to the chest interrupts a beating heart, causing ventricular fibrillation, which means the heart's electrical activity becomes disordered. The ventricles flutter rather than beat while the heart pumps little or no blood.

The impact doesn't have to be hard. "Most of them are at a low velocity," Maron said.

Little League balls generally are thrown at speeds of 40 or 50 mph, he said, but it doesn't have to be that fast.

While commotion cordis most often occurs during sports such as baseball, lacrosse or hockey, any situation in which a projectile strikes the chest can trigger it.

Usually children are the victims, although one person on the registry was 45 years old.

With such a precise blow, death is highly likely; the fatality rate is 85 percent, Maron said.

"It might have something to do with the size of the rib cage," he said.

The ribs don't hug a child's heart as tightly as an adult's.

An autopsy performed Friday at the Hillsborough County Medical Examiner's Office showed Cayden died of ventricular fibrillation caused by a blunt impact to the chest, Investigator Harrison Cowan said.

Commotio cordis doesn't show up as a cause of death in an autopsy, Maron said. That's because the heart suffers no structural damage. Anecdotal information is used to finger "CC" as the culprit.

Maron recalled another fatal case involving a 4-year-old boy who was hit by a hollow, plastic bat thrown by a playmate.

"It's sort of inconceivable," Maron said. "... We have cases this young. There's not too many."

A computer search of news archives turned up a handful of cases in which blows to the chest proved fatal.

A baseball killed a 10-year-old boy in Japan in 2002. The following year, errant pitches killed a 15-year-old in Cold Spring, Ky., and a 13-year-old in Fayette County, Ga.

A 23-year-old St. Petersburg man died minutes after a soccer ball struck him in February 2001.

And in March 1990, a 10-year-old Tampa boy died from a wild pitch during a Little League game.

Baseball Group Issued Advisory

USA Baseball, which oversees more than 12 million amateur players in ballparks and playgrounds across the country, issued a safety advisory more than four years ago.

"Prevention of commotio cordis is currently best provided by appropriate coaching. Batters should learn ball avoidance and turn away from an inside pitch and not open chest to the impact, as is so typically the case," the advisory states.

"... In conclusion, commotio cordis is a risk for all sports in which a projectile can strike the chest of a participant, but fortunately it is a very rare event."

Maron said there is no way to completely prevent such a death. Cayden's, he said, is particularly poignant.

"Cases like this do underscore for young children not to be struck in the chest for any reason," Maron said.

The well-maintained park where Cayden died wasn't crowded Friday afternoon. A woman watched two small children on a swing-set, while a couple of older children rode bikes.

Next-door neighbor John Boore said he often saw Cayden with his brothers and other children at the park and in their yard.

"I'd see them playing with a football or baseball; just kid stuff," Boore said. "Cayden was just active, and always seemed really happy. He was often with some of the older kids, just having fun and enjoying childhood."

Tribune researcher Buddy Jaudon contributed to this report. Reporter Lisa A. Davis can be reached at (727) 815-1083 or ldavis@tampatrib.com. Reporter Geoff Fox can be reached at gfox@tampatrib.com or (813) 948-4217.

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