Damar Hamlin suffered a "cardiac arrest" during the Buffalo Bills' game against the Cincinnati Bengals Monday night, leaving many questioning: what caused a 24-year-old healthy athlete to suddenly collapse on the field?
The 6-foot-tall, 200-pound Hamlin was injured while tackling Bengals receiver Tee Higgins on a seemingly routine play that didn’t appear unusually violent.
Hamlin quickly got to his feet, appeared to adjust his face mask with his right hand, and then fell backward about three seconds later and lay motionless as many watched in horror on the field, in the stadium and on televisions at home.
"His heart most likely stopped once he stood up, and he was no longer able to get blood flow around his body into his brain," said Dr. Marlon Everett, a cardiologist at Advocate Aurora Healthcare.
Though Everett is not involved in Hamlin's care, he believes after watching what happened that the hit Hamlin took led to his cardiac arrest.
"It was the perfect storm of his heart in that place and he subsequently had this commotio cordis episode," Everett said.
Commotio cordis is described as "ventricular fibrillation precipitated by blunt trauma to the heart," according to the National Library of Medicine.
Sports
Northwestern Medicine noted there have only been 200 cases of commotio cordis reported since 1995.
While it is extremely rare, it is most commonly diagnosed in athletes.
Feeling out of the loop? We'll catch you up on the Chicago news you need to know. Sign up for the weekly Chicago Catch-Up newsletter here.
"Commotio cordis may occur in athletes who are hit hard in the chest by sports equipment or by another player," the Mayo Clinic reports. "This condition doesn't damage the heart muscle. Instead, it changes the heart's electrical signaling. The blow to the chest can trigger ventricular fibrillation if it strikes at a specific time in the signaling cycle."
The rarity of the condition comes in the timing. Commotio cordis must take place at a very precise moment in a single heart beat to cause cardiac arrest, which can be fatal.
Everett is not alone in his analysis. Multiple medical experts speculate that Hamlin suffered an episode of the rare condition.
“From watching the events of last evening, some cardiologists may suspect a rare condition known as commotio cordis, which is a sudden strike to the chest and heart that can cause the patient to lose consciousness,” said Dr. Kannan Mutharasan, associate professor of cardiology at Feinberg and co-director of Northwestern Medicine’s sports cardiology program. “That is a rare condition that can happen in any contact sport. It’s not something you can screen, we don't know the risk factors but do know the consequences. It is a very unfortunate occurrence.”
Dr. Brian Cole, a sports medicine orthopedic surgeon and the head team physician for the Chicago Bulls, told NBC Chicago there are only a handful of other options for what caused Hamlin's sudden cardiac arrest. But one of the more common causes likely would have been detected already - a condition known as hypertrophic cardiomyopathy, which is a disease in which the heart muscle becomes thickened.
Northwestern Medicine said while HCM is common, it can be "underdiagnosed and associated with sudden death in younger athletes." But Cole said preseason screenings likely would have shown signs of the condition.
"Most of us know a lot about the heart anatomy because preseason all of these elite athletes undergo cardiac screening. So sometimes that's just an EKG or a stress test and other types of MRIs, so we have a really good understanding what the anatomy of the athlete's heart is," Cole said. "And so hypertrophic cardiomyopathy is not something that's subtle, and it's something that, you know, we would screen a player for in preseason. So you would know coming in, typically. It wouldn't be missed."
That leads Cole to also believe that Hamlin's collapse was likely caused by commotio cordis.
"We don't have a direct confirmation that it's commotio cordis, but a direct blow to the chest, especially a thinner athlete, can lead to this cardiac event or a rhythm called ventricular fibrillation, which is the most common type of arrhythmia in the setting," he said.
It's important to note that while Hamlin suffered cardiac arrest, that is not the same as a heart attack.
Although a heart attack and cardiac arrest both involve a destabilization of the heart, and they may look similar to a lay person, they are very different and should be treated differently, according to the American Heart Association.
A heart attack occurs when the blood flow to the heart is blocked, often due to a blockage in a coronary artery. A heart attack often occurs alongside chest pain.
Cardiac arrest, however, occurs when there is a sudden disruption to the electrical malfunction in the heart, which causes the heart to be unable to pump oxygen to the brain, lungs and other parts of the body. A person experiencing sudden cardiac arrest will collapse and not have a pulse.
In Hamlin's case, many experts are crediting health care staff who immediately performed CPR with potentially saving the player's life.
In a chilling scene, CPR was administered to the 24-year-old safety for nearly 10 minutes, ESPN reported during the broadcast. Hamlin was ultimately rushed to the hospital in critical condition.
“His heartbeat was restored on the field and he was transferred to the UC Medical Center for further testing and treatment,” the Bills said early Tuesday morning.
Hamlin remained in critical condition in the intensive care unit at the University of Cincinnati Medical Center Tuesday afternoon, the team stated.
"The immediate response by the health care staff, as well as the paramedics is really probably what got him off the field still, you know, with a functioning heart rate and a chance to survive here," Cole said.
Everett said he hopes the event raises awareness about the importance of CPR.
"One of the unfortunate things is that it happened on national TV, but one of the fortunate things is that happened on national TV that can hopefully bring awareness to everyone learning CPR," he said.
Hamlin's family also thanked the medical professionals who "provided exceptional care" at the time of his collapse.
"We also want to acknowledge the dedicated first responders and healthcare professionals at the University of Cincinnati Medical Center who have provided exceptional care to Damar," the family's statement, released by Hamlin's marketing rep Jordon Rooney, read. "We feel so blessed to be part of the Buffalo Bills organization and have their support."
And Everett said there's "reason for hope."
"Number one, he's young. He's a world class athlete, and it was recognized early that he was in trouble,” he said.
