Commotio cordis is a term used for cases of sudden cardiac death due to 
nonpenetrating chest trauma without evidence of underlying myocardial disease or 
injury. Contusio cordis has been reserved for cases of chest trauma where there 
is cardiac bruising. Three deaths due to blunt cardiac and chest trauma after 
vehicle accidents are presented where the only significant injuries were 
contusions of the heart and fractures of the sternum and ribs. One case had 
moderate coronary artery atherosclerosis and another had a blood alcohol level 
of 0.218%. Given that individuals with cardiac bruising, chest trauma, coronary 
atherosclerosis, and alcohol intoxication may still die of the same mechanisms 
as in classic commotio cordis, and that these entities represent a spectrum of 
findings after chest impact, it may be more useful to separate cases into 
related subcategories: (A) those with no evidence of injury or underlying 
cardiovascular disease, (B) those with chest wall fractures, chest wall 
contusions and/or cardiac contusions, and (C) those with underlying 
cardiovascular disease or the presence of substances such as alcohol or drugs 
that may reduce the threshold for cardiac arrhythmias. As there may be cases 
with a number of these factors, a fourth category (D) includes those with a 
combination of injuries and predisposing factors (ie, categories B and C). 
Including cases such as these under the diagnostic umbrella of commotio cordis 
may demonstrate that a wider range of individuals are at risk for death from 
blunt cardiac trauma than sports-playing adolescents.