Doctor Plays Hardball With Mysterious Disorder

Tufts Dr. Mark Link is working on research which could help prevent a rare heart injury from killing more young athletes.

Newton, Mass. [08-02-04] While reading an article in the New England Journal of Medicine nine years ago, Dr. Mark Link first learned of a mysterious disorder linked with the deaths of dozens of young baseball players. Hit by balls during games, the otherwise healthy players dropped dead of heart failure. Link – an expert in cardiology and a softball lover – wanted to find out why. Many hope the Tufts graduate’s latest research, which he plans to publish this fall, will prevent future fatalities.

“I would hate to see any parents or kids not play sports because of this,” Link – the father of young children who are beginning to play baseball and softball – recently told The Boston Globe.

For nearly a decade, Link – an associate professor of medicine at Tufts who heads the Center for the Evaluation of Heart Disease in Athletes at Tufts-New England Medical Center – has been steadily deciphering the rare and mysterious condition, called commotio cortis.

“Commotio cortis means death from a sudden blow to the chest wall – the impact usually comes from a baseball or other sports ball,” reported the Globe. “The disorder kills 10 to 20 people a year who happen to get hit at precisely the wrong time during their heart’s rhythmic beat.”

On average, the human heart beats 100,000 times a day. As Link has discovered, a relatively soft blow can be fatal when the timing and location are right.

“The impact has to occur directly over the heart,” Link told Good Morning America after a seven-year-old died from the condition in 2002. “It has to occur during a very narrow time segment of the cardiac cycle, which is about one to two percent of the cardiac cycle. It’s also important that the energy of impact is correct. It can’t be too fast or too slow.”

Which helps explain why so many kids – not adult athletes – are killed by the disorder.

“According to Link’s research, the deadliest balls are those traveling roughly 40 miles per hour,” reported the Globe. “Most victims are between six and 15 years old, who can’t yet throw at faster speeds. Link is trying to create a biomechanical model to better understand the causes.”

Research from experts like Link could lead to better protective gear and equipment.

Safety balls – which feel like standard balls, but reduce the force of impact -- are a good example. Studies have shown that they significantly reduce the risk of commotio cordis.

Link recommends parents encourage their children to play with age-appropriate safety balls rather than standard, harder, baseballs.

“I tell them to use some common sense,” Link told the Globe. “If you have a 7-year-old kid, they should be playing with a 7-year-old safety ball.”

It’s good advice to follow, even if the child is wearing protective equipment.

“Unlike athletic helmets, there are no standards to guide the design of chest protectors,” reported USA Today. “There is little, if any, medical input in the designs of most chest protectors, and [Link says] recent studies show that commercially sold chest protectors offer no protection against commotio cordis.”

They may reduce the pain of certain blows, but they don’t prevent their potentially harmful effects.

“There’s not much science behind the chest wall protectors that I’ve ever seen,” the Tufts graduate told USA Today. “I suspect that they’re made to market so they look good, and it feels soft and it feels like it should work.”