**Episode Title: "EP390: Commotio Cordis and Nocturnal Leg Cramps"**
**Dr. Auric Bishop:** Welcome, my name's Dr. Auric Bishop. I'm a cardiologist, an author, and a keynote speaker. I'm CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes, someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, and cholesterol for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love.
**Warwick Bishop:** G'day, Warwick Bishop here and welcome to my podcast and videocast station. Hey, I really do appreciate you tuning in, and I really hope you find the stuff informative, interesting, and helpful. And if you do, please share it. And if you don't, please don't tell people. Or feedback to me what you'd like to hear about. You can do that through info at drwarwickbishop.online or just go to my website and fiddle around until you get the help button, and you can communicate with me through that. It's all on the website, all really straightforward.
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Having said all that, I'm going to say this. Today I'm going to talk about commotio cordis and I'm going to talk about leg cramps—two ends of the spectrum of frequency. Commotio cordis, thankfully uncommon; nocturnal leg cramps, unfortunately fairly common. And you may have noticed I'm telling you what I'm going to talk about, then I'm going to talk about what I'm going to talk about, and then I'm going to remind you what I told you about at the end, based on some excellent feedback I've had from some of my regular listeners.
So, let's kick off with commotio cordis. Do you know what that means? Nope? Well, it doesn't matter if you don't. I'm going to tell you. Commotio cordis is a term that's used mainly in cardiology because it relates to the heart. It's all about a significant blunt force trauma to the chest leading to cardiac arrest. It really talks about commotio cordis being the loss of regular rhythm of the heart from an impact. So it's pretty significant if it occurs. Thankfully, it's pretty uncommon. But it is a cause of sudden cardiac death in young athletes.
You can think of the sort of things that might cause it. A mountain bike, for example, hitting a tree stump with your chest. Terrible to visualize, but you can imagine that's a significant impact. Being hit by a cricket ball square in the chest could do it. A ball going very quickly, particularly if someone received the ball as a ball that was going very quickly and then whacked it really hard, and that hits someone smack in the chest. It's that sort of blunt force trauma that we believe can throw the heart into a chaotic and life-threatening rhythm.
As I said, luckily, it's really uncommon. In the United States, they estimate about 10 to 20 cases per year. I think that might be under-predicted. Remember that would be equated to a similar population number in Australia—just a handful of people per year, thankfully. So, it's generally seen in males under 20. We talked about maybe cricket would be a risk factor, or you could imagine playing cricket could put you in the situation where the impact could occur. I guess baseball is the same. Hockey and lacrosse could be similar. I'm not sure about golf because it's a smaller-sized ball or projectile.
But if you think about it, these are the sort of things that could really whack the heart and possibly catch it at a particular part within the cardiac cycle, which is an electrical energy cycle, and could cause disruption to that electrical signal and throw the heart into a life-threatening rhythm. There's a little bit of work around it. There is a suggestion that chest protectors can reduce the risk of commotio cordis but doesn't eliminate it altogether.
It's probably really important that sporting events, wherever possible, try and have access to automated external defibrillators. This really is a condition that if you can get someone within that 180 seconds, you can make a massive difference in their opportunity to survive, but more importantly, on their functional capacity for the rest of their life. Once we get past that 180 seconds, then the risk of brain damage starts to take off. So, automated external defibrillators at sporting events makes perfect sense.
So, commotio cordis—a fascinating condition, thankfully incredibly rare. Let's talk about something that is a fair bit more common, and that's nocturnal leg cramps. A lot of people suffer from this. It's been quoted that nearly as many as 40% of adults over 50 years of age can experience these cramps. They can last from seconds to minutes. They're obviously distressing. They can be related to things like dehydration and electrolyte imbalance.
I get plenty of patients reporting that they believe their statin therapy is contributory. I'm not sure we've got good data on that, but I certainly have that reported by some patients as well. Other medical conditions probably contribute, such as poor circulation, nerve dysfunction, and muscle fatigue for whatever reason. Drugs, as I said, statins could be implicated, but things like diuretics, which can alter electrolyte balance, could feed into this as well. We know beta blockers, which we use a lot for heart conditions, can alter blood flow responsiveness as well, and that also could feed into it.
So, there are lots of potential causes, and we don't often get great answers. It's hard to know what the best thing to do is. There's been a little bit of research. Probably one of the best strategies is actually spending a bit of time stretching the calves before going to bed. So, if you are someone who suffers from nighttime cramps, or you know someone who does, maybe suggest to them that the very first thing and the best thing they could try is to stretch out those calves before going to bed.
Now remember to do that calf stretch with a straight leg. When you do that, you're stretching the gluteal muscles there. But also do the calf stretch with a bent knee and foot flat on the floor. If you don't know what I mean, fiddle around with doing that and you'll feel it. You can take the stress or the stretch off the gluteus and apply it to the soleus, which is the deeper muscle in the calf. So what you really need to do is stretch those legs out and take a bit of time to do it and get both of them done so that you know you're really getting them properly stretched.
You probably need 30 seconds or so. You'll feel it—the gastrocnemius would be the top one; it's in two heads, it goes to each side of the knee, and below it is the soleus. You don't need to remember those names, but you'll feel it as you stretch that leg. Take a bit of time to do it properly and see if that makes a difference. That's one of the things that's reckoned to be beneficial.
People do try things like taurine and quinine, which is hard to get hold of. You used to be able to get hold of it in Indian tonic water, but not as much anymore. Magnesium—lots of people talk about magnesium potentially being beneficial, but the evidence is slightly limited there. There's also a little bit of encouragement with an agent called vitamin K2. There's been a bit of promising recent research on that. Vitamin K2—that's not K1, but it is related to K1. K2 is referred to as menaquinone and has a role in calcium metabolism, sort of making sure that calcium stays in the bones and doesn't end up in the tissues.
So maybe if there's any question of potential issues with bone health and you've got cramps in the legs, vitamin K2 with a D supplement might be a really good thing to entertain and consider.
Well, that's it for commotio cordis and for nocturnal leg cramps. I've told you about commotio cordis, thankfully. That impact in the chest which leads to sudden cardiac death is rare, thankfully. And nocturnal leg cramps—see if there's anything in the medication list that could be playing up or contributing. Maybe speak to the doctor about changing that. Importantly, really try and do some good stretches. Stretch those legs out, those calves, that soleus before you go to bed. Stretch both those muscles. Think about K2 and magnesium and see how you go.
So, I'm going to wrap it up there. I hope you've enjoyed this. I hope you found it entertaining and informative because if it's not entertaining and informative, you won't listen. I hope you tune in again and I hope you share and subscribe. For now, I am going to wish you the very best. I do hope you live as well as possible for as long as possible. Take care and bye for now.
**Dr. Auric Bishop:** Hi. Ever wondered what your risk of heart attack is? You should. It's the single biggest killer in the Western world. We're talking one death less than every 30 minutes in Australia. One death less than every 60 seconds in the United States—9 million deaths globally per annum. Well, how do you check your risk? You can go to www.virtualheartcheck.com.au. You'll find out about your risk and what can be done beyond that to be even more precise.
