Q: In my WIP I was planning to have someone killed by a strong blow to the chest. I know death has occurred this way in children, specifically young baseball players who get hit in the chest by a ball or bat. Could such a blow kill a grown man?
Nora Barker, Author of Murder in Primary Colors
A: This is an extremely rare occurrence but can happen in either children or adults. A blow to the chest can cause a cardiac death in several ways.
The trauma could be of sufficient force to directly damage the heart muscle, causing it to rupture, resulting in sudden death. Or, a heart valve could be damaged so severely that the heart could no longer function efficiently as a pump and the victim could die from the resulting shock. Here death could take many minutes or hours. The blow could bruise the heart muscle (called a cardiac contusion) and this could cause a deadly cardiac arrhythmia, again with sudden death.
Also, the trauma, even without an overt cardiac contusion, could cause electrical instability and a deadly arrhythmia–usually either ventricular tachycardia (VT) or ventricular fibrillation (VF).
Another possibility is that the force of the chest trauma could cause the heart to be propelled backward where it could bounce against the spinal column. The atrioventricular node (AV node or AVN) is found on the back side of the heart. It is the relay station that carries the heart’s electrical pulses from the upper chambers to the lower chambers. If the AVN is bruised or damaged, complete heart block, where no electrical impulses travel through the AVN, could result. If so the heart rate might drop to 25-30 per minute and this could lead to sudden collapse and death.
So yes a blow to the chest can kill by any of these mechanisms but each is exceedingly rare and very unpredictable. This unpredictability makes it a poor choice for murder as killers like things to be more certain—like gunshots and stabs and poisons. Still, it’s possible.