Medical Terminology Daily (MTD) is a blog sponsored by Clinical Anatomy Associates, Inc. as a service to the medical community. We post anatomical, medical or surgical terms, their meaning and usage, as well as biographical notes on anatomists, surgeons, and researchers through the ages. Be warned that some of the images used depict human anatomical specimens.

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A Moment in History

Andreas Vesalius Bruxellensis (1514- 1564)

A Flemish anatomist and surgeon, Andreas Vesalius was born on December 31, 1514 in Brussels, Belgium. He is considered to be the father of the science of Anatomy. Up until his studies and publications human anatomy studies consisted only on the confirmation of the old doctrines of Galen of Pergamon (129AD - 200AD). Anatomy professors would read to the students from Galen's work and a demonstrator would point in a body to the area being described, if a body was used at all. The reasoning was that there was no need to dissect since all that was needed to know was already written in Galen's books. Vesalius, Fallopius, and others started the change by describing what they actually saw in a dissection as opposed to what was supposed to be there. 

Vesalius had a notorious career, both as an anatomist and as a surgeon. His revolutionary book "De Humani Corporis Fabrica: Libri Septem" was published in May 26, 1543. One of the most famous anatomical images is his plate 22 of the book, called sometimes "The Hamlet". You can see this image if you hover over Vesalius' only known portrait which accompanies this article. Sir William Osler said of this book "... it is the greatest book ever printed, from which modern medicine dates" 

After the original 1543 printing, the Fabrica was reprinted in 1555. It was re-reprinted and translated in many languages, although many of these printings were low-quality copies with no respect for copyright or authorship.

The story of the wood blocks with the carved images used for the original printing extends into the 20th century. In 1934 these original wood blocks were used to print 617 copies of the book "Iconaes Anatomica". This book is rare and no more can be printed because, sadly, during a 1943 WWII bombing raid over Munich all the wood blocks were burnt.

One interesting aspect of the book was the landscape panorama in some of his most famous woodcuts which was only "discovered" until 1903.

Vesalius was controversial in life and he still is in death. We know that he died on his way back from a pilgrimage to Jerusalem, but how he died, and exactly where he died is lost in controversy. We do know he was alive when he set foot on the port of Zakynthos in the island of the same name in Greece. He is said to have suddenly collapsed and die at the gates of the city, presumably as a consequence of scurvy. Records show that he was interred in the cemetery of the Church of Santa Maria delle Grazie, but the city and the church were destroyed by an earthquake and Vesalius' grave lost to history. Modern researchers are looking into finding the lost grave and have identified the location of the cemetery. This story has not ended yet.

For a detailed biography of Andreas Vesalius CLICK HERE.

Personal note: To commemorate Andrea Vesalius' 500th birthday in 2014, there were many scientific meetings throughout the world, one of them was the "Vesalius Continuum" anatomical meeting on the island of Zakynthos, Greece on September 4-8, 2014. This is the island where Vesalius died in 1564. I had the opportunity to attend and there are several articles in this website on the presence of Andreas Vesalius on Zakynthos island. During 2015 I also attended a symposium on "Vesalius and the Invention of the Modern Body" at the St. Louis University. At this symposium I had the honor of meeting of Drs. Garrison and Hast, authors of the "New Fabrica". Dr. Miranda

 "Clinical Anatomy Associates, Inc., and the contributors of "Medical Terminology Daily" wish to thank all individuals who donate their bodies and tissues for the advancement of education and research”.

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Commotio Cordis

Published: Tuesday, January 02, 2024 07:00 | Written by: Efrain A. Miranda, Ph.D. | Hits: 1853

UPDATED: One year ago, on Monday January 2nd 2023, Damar Hamlin suffered a cardiac arrest as a consequence of a tackle that impacted his chest. The football player had suffered a Commotio Cordis, a rare but known athletic cardiac injury that was reversed by the medical support teams present at the Cincinnati Football Stadium.

One year later, the University of Cincinnati has published a press release entitled "The Damar Hamlin Effect: Revolutionizing CPR and AED Training Nationwide".  Because of this accident, the awareness for training  in CardioPulmonary Resuscitation (CPR) and the need and availability of Automated External Defibrillators (AEDs) has increased. His foundation has to-date raised over 9 million dollars!

Following is the original (and updated) post:

I have received several questions regarding this term and its meaning, because of the cardiac arrest suffered on the field by the Buffalo Bills defensive player Damar Hamlin while playing the Cincinnati Bengals on January 2nd, 2023.

01/02/2023 Bengals stadium - Public domain
01/02/2023 Bengals stadium

For those who were watching the game, close to the end of the first quarter Hamlin blocked another player in what looked like a normal and standard play. Immediately after, Damar Hamlin stood up and immediately collapsed. The video can be seen here. The player was treated on the field and later reports indicated that he had suffered a cardiac arrest and was treated with CPR (manual cardiopulmonary resuscitation), the use of an AED (Automated External Defibrillator) and oxygen. The player was intubated and was considered to be in critical, but stable condition.

The consensus is that Damar Hamlin suffered a ventricular arrhythmia, which allowed the heart to beat erratically, but not be able to pump blood, which is why he had to be defibrillated using the AED.

The cause for this is an uncommon (30 cases per year in the US) but known situation known as Commotio Cordis, a ventricular dysrhythmia caused by a sudden hit to the sternum in a particular location*. It has been seen in baseball and softball players where the pitcher is hit in the sternum by a fast ball coning from first base. Also seen in lacrosse players. In most cases this happens in younger individuals where the four sternabrae that form the body of the sternum have not yet completely ossified, making the sternum and lower costal cartilages quite flexible, being able to “bend in” when hit directly and compress the heart.

As some of you may know, I am a 7th Degree Black Belt in Goju-Ryu Karate. This type of punch to the sternum is one of the many techniques used in advanced Martial Arts. In most cases this punch will slow down an opponent, but it does not cause Commotio Cordis. It is a technique that should only be practiced under very close supervision. In fact, this technique was thought to be legend and was called “the touch of death” in China.

Commotio Cordis at a karate tournament
Commotio Cordis at a karate tournament

An example of Commotio Cordis caused by a Karate punch can be see in the following YouTube video. The image in this article shows the instant the chest strike happens at 6 seconds in the video. Look at the hand of the practitioner on the right and the devastating consequence that follows. Please note the similarity of the situation in this video and what happened to Damar Hamlin. There is a lapse of time between the Commotio Cordis cardiac arrest where the athlete gets up or walks followed fainting and unconsciousness.  What is distressing is that the young martial artist who suffered this devastating injury died at the tournament. The judges were not aware of the situation, no one felt his pulse, or started life-saving CPR. Because of the content this video is age-restricted and you may have to sign in to view it.

The words are Latin. Commotio means “agitation or commotion”. Cordis means heart. The conditions to cause Commotio Cordis need to be exact, as the heart needs to be in ventricular repolarization, when the heart ventricles are starting to refill with blood. The "window" for a sternal hit to cause Commotio Cordis is very small.

Please, if you do not know how to provide CPR, take a full CPR course or at least attend a short 10 minute training like the one provided by University of Cincinnati Health in their "Take 10 Cincinnati" program.

For additional information please visit StatPearls at https://www.statpearls.com/ArticleLibrary/viewarticle/19761