Commotio Cordis

To the Editor: The article by Maron and Estes (March 11 issue) 1 provides an excellent review of commotio cordis. An issue that occasionally arises in forensic practice concerns sudden death after blunt chest impact in older persons who have underlying cardiovascular disease or have sustained nonlethal chest trauma. A typical example involves an elderly driver who hits the steering wheel during a car accident and has nonlethal chest-wall injuries, such as a rib fracture or soft-tissue bruising. On autopsy, no anatomical cause of death may be found. According to established definitions of commotio cordis, 1 , 2 such an injury would not . . .