Screenings may give tragedies the ol' stiff arm, save youth lives By JAKE LINGER Sports Editor
The chances of a young athlete dying from a heart-related ailment while participating in sports are miniscule. When it does happen it is usually going to be from a pre-existing condition.
And while the incidence of cardiovascular illness or death in athletes competing in an athletic event is approximately five in 1 million, if one of those five is a loved one, it's traumatic when it happens and the great odds don't matter.
Unlike most other sports-related illnesses or injuries, there is little chance for prevention of heart problems once a person is participating. There is literally no guarantee that such catastrophic events can be avoided.
Symptoms
Any symptom short of an athlete simply falling to the ground is extremely difficult to recognize and the response time for treatment is far more critical and usually takes on-site emergency equipment to save the life of a cardiac victim.
Screening high school athletes for pre-existing conditions is "really a huge issue," according to Dr. Stephanie Jacobs, a local consultative cardiologist with Cardiology Associates. Jacobs talked about the need for and difficulty of screening prospective athletes, a subject that has also been addressed by the American Heart Association, the American College of Cardiology - both of which have recently come out with new guidelines for screening - and the National Football Foundation.
"It gets a lot of media attention when someone young and healthy dies suddenly. It's just not common. It shakes us because they are the people who should be best at whatever is going on," the doctor said.
Yet, the subject of screening for cardiovascular abnormalities, which is a giant step beyond the usually minimal physical examination required for every high school athlete, is controversial. It would be a massive undertaking.
Jacobs pointed out it is difficult to test everyone because of the vast numbers of young people participating in sports programs and because there are so many different tests.
Complete screening is considered cost prohibitive because of the number of properly trained physicians and technicians needed and the equipment and personnel needed to administer the tests.
However, it's something that should be done whenever possible.
Conditions
The AHA, which admits in its report that "there is no cost-effective battery of tests to identify all, or even most, dangerous cardiovascular conditions," recommends a national standard for some form of preparticipation cardiovascular screening for high school athletes.
"Why young people, who should otherwise be healthy, have sudden death are some structural abnormalities of the heart, hereditary things such as hypertrophic cardiomyopathy, a condition where the heart muscle is thicker than it should be and sets up an abnormal heart rhythm that accounts for about one-third of sudden athletic deaths in this country," Jacobs said.
Another condition is arrhythmogenic right ventricular dysplasia, which is the next most common cause, followed by problems with the coronary artery that when you increase activity increases the risk factor, abnormal electrical problems that predispose you to an abnormal rhythm.
Other categories are undiagnosed carotid artery disease and congenital heart problems that people have lived with since birth.
There are rare traumatic injuries that have caused sudden cardiac death, such as being hit in the chest by a ball or, as happened recently to a baseball coach, being hit by a batted ball in the carotid artery, which through unbelievably rare timing might precipitate an abnormal heart rhythm.
Family history
"The AHA has created a preparticipation screening questionnaire that talks about 12 points that includes a family history and a personal medical history ... it helps to determine the risks in terms of genetics," Jacobs said.
"A lot of times kids don't know what (diseases or conditions) their parents or other blood relatives had and because of that the guidelines for anyone under 18 recommend that parental confirmation is utilized."
It is extremely important for young people to know as much as possible about their family history beyond their parents in regard to existing cardiovascular conditions. It could help make decisions as to the tests necessary to identify specific problems known to cause sudden cardiac death or disease progression in young athletes.
Knowledge
Jacobs attempted to dispel the idea that a heart ailment must keep an athlete from participating. She noted that some young athletes are scared of that happening and won't admit to anyone that they are having chest pains or other symptoms, something she said is dangerous.
The doctor pointed out that many athletes with some forms of heart disease can and do compete and are totally fine with it, and that it's up to physicians to decide whether or not someone should be disqualified from participating.
"That's the next step after screening, to be able to say 'what do we do with this information?' That really matters in this country where we have athletes who are making millions of dollars," Jacobs explained. "To disqualify someone from all the social and financial benefits can be traumatic diagnosis to give to somebody."
She also talked about some tests, particularly an EKG, that might be done in the screening process that could create false positives, particularly for murmurs, that could keep potential athletes from being permitted to play. That is one of the adverse affects of screening, but there are more positives for risk reduction.
Preparedness
As with any injury or illness in sports, it would be helpful to have medical personnel or a certified athletic trainer on site at every sports practice and game. That is, unfortunately, neither economically nor logically possible.
Part of the problem with cardiovascular problems is that young athletes seem to believe they are indestructible and if they do feel a chest pain or other symptom they will often ignore it rather than mention it to anyone who might see that as complaining about it.
Also, it is difficult for a coach or parent or sometimes even a trained medical technician or athletic trainer to recognize that an athlete is having a problem. However, in that regard, because there is a tiny window of safety in a cardiac event, there should be such emergency equipment as a portable defibrillator on site.
"The first line of defense is symptoms," Jacobs said. "Exertional chest pains, dizziness or passing out, unexplained fatigue or breathlessness are all suggestive symptoms and should be evaluated further by a cardiologist."
And, anyone with a history of exercise intolerance or who has been diagnosed with a murmur should be watched more closely and taken out of the environment they're in.
It would be best to have an ambulance at as many events as possible. However, if there is no ambulance, one should be called as quickly as possible if an athlete appears to have any of the cardiovascular symptoms. If there is truly a problem, there is about three to five minutes at the maximum to save a life, which is the reason for a defibrillator and someone who knows how to use it at the field.
Sports writer Joe Gross contributed to this story.
