Ultimately I feel that what we're trying to do is make sense of what we all thought was unthinkable; that a young, healthy, fit man suffered a cardiac arrest in the middle of a widely-televised football game. And, in the moment, we, as physicians, are all trying to come up with a differential for why or how the unthinkable could possibly happen...because that's what we do. And here is where I feel Occam's razor is most pertinent; what's the "most likely" explanation for what occurred in the absence of available background information, which, honestly, is what you all deal with in emergency medicine (ie undifferentiated sick patients) on a daily basis? You don't have to know whether he had HCM, or long QT syndrome, or Brugada syndrome, to know that the man suffered a cardiac arrest. We know based on the available information that he required CPR and defibrillation in the field. On review of the video, he took at least one, if not more blows to the chest prior to him collapsing on the field. To me, though it is an exceedingly rare diagnosis, commotio cordis would fit the bill as to why what happened...happened. You don't need a channelopathy, HCM, long QT, or (can't believe I need to mention this but apparently "speculation" is already out there), "myocardial inflammation" for something like this to occur or make it "more likely" to occur. All you need are the appropriate set of circumstances (energy delivered to precordium at exceedingly poor timing of cardiac cycle) for commotio cordis to occur.
