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Heart of the matter
More than 18 years after Loyola Marymount All-American Hank Gathers collapsed during a basketball game and died shortly thereafter, mysteries remain about sudden cardiac death and the leading killer of young athletes, hypertrophic cardiomyopathy (HCM).
“There’s a lot of stuff that’s still unknown, starting with diagnoses,” said Ted Abraham, a cardiologist and HCM researcher at Johns Hopkins. “A lot needs to be learned about this.”
On Saturday at Morgan State’s Hurt Gymnasium in Baltimore, a landmark event might shed considerable light on the subject and perhaps help save a life or two. In what might be the most extensive and ambitious project of its type in this country, the “Hopkins Heart Hype” will try to provide free heart screenings for up to 1,000 athletes participating in the Maryland high school track and field championships.
Led by Abraham, Hopkins cardiologists and interns and an army of medical students, nurses and other personnel will employ state-of-the-art equipment to conduct tests to help detect HCM and other heart abnormalities.
In addition to serving the athletes, Abraham said the event will provide a wealth of information vital to doctors and the medical community as a whole in diagnosing a disease that often is hard to detect.
“We will be able to get thousands of points of data,” he said.
HCM results from a genetic mutation and usually causes a thickening of the left ventricle wall (the lower chamber), which restricts blood flow. About 500,000 Americans have HCM, and many don’t know it. It is not necessarily fatal, although young athletes, ironically, are considered high-risk, especially because they’re in such apparently good health and often experience no symptoms.
According to figures quoted by Abraham, 20 to 25 high school athletes die from sudden cardiac death every year. But the total of athletes under age 35, including college and professional athletes, who die after competing in sports-related activities, is much higher. Experts in the field put the annual figure at between 100 and 125, but even that might be conservative. However, Abraham said, “Not everyone with HCM is in danger of keeling over or having cardiac arrest.”
If HCM is detected, the first course of action is to cease competitive athletics. But light to moderate participation remains viable, Abraham said. Medication and monitoring also are part of living with HCM. In extreme cases, a defibrillator can be implanted in the chest to reverse sudden cardiac arrest.
Although Gathers likely suffered from cardiomyopathy and not HCM specifically, the subject became ingrained in the public consciousness when he died in 1990. A popular and talented player, Gathers had received treatment for an irregular heartbeat. He died shortly after collapsing on the court, an event recorded on video and replayed countless times.
HCM, while not a likely cause of Gathers‘ death, has not been completely ruled out. However, it was a definitive cause of the 2005 deaths of Thomas Herrion of the San Francisco 49ers and the Atlanta Hawks‘ Jason Collier.
Other athletes, such as Reggie Lewis of the Boston Celtics, Damien Nash of the Denver Broncos and Joe Kennedy of the Oakland Athletics, have died of sudden cardiac arrest, although HCM was not a certain nor a probable cause.
Whenever a prominent athlete is suddenly struck down, “the media are all over it,” Abraham said. “And then it dies down. Parents forget about it. Coaches forget about it. What we’re trying to promote is a long-term program [of awareness].”
Routine physicals rarely detect HCM. An electrocardiogram (EKG) can be effective, but even better is the echocardiogram, which is much more sophisticated. Italy has paved the way in preventing sudden cardiac arrest by requiring athletes at all levels to be screened, and the International Olympic Committee has recommended it. In the United States, only the NBA uses advanced technology to screen athletes for potential heart problems.
Full-blown testing is expensive and requires expertise. Only a few colleges do heart screenings, notably Stanford, which only recently began testing on a voluntary basis and has its own HCM center. It’s rare in high schools as part of the typical preparticipation physical.
“We’re lucky. We have lots of young medical students and residents,” said Dr. Euan Ashley, director of the Stanford Hospital HCM Center. “The argument is always financial.”
An EKG costs about $50, but an echocardiogram costs upward of $1,000. Some of the equipment is costly, as is finding the right people to interpret the results.
“Doing an EKG is not hard,” said Lisa Salberg, founder and chief executive officer of the Hypertrophic Cardiomyopathy Association. “Reading what’s on the paper is harder than what most people think. The nuances are so subtle, the line between normal and abnormal really needs to be evaluated by a really skilled eye.”
Salberg said HCM often is misdiagnosed as something else, usually asthma, a heart murmur or panic or anxiety attacks.
“We need to look at these kids more closely,” she said.
But right now it’s not cost-effective. Still, Abraham said any athlete diagnosed with HCM or another abnormality Saturday can receive follow-up treatment regardless of their financial or insurance situation.
In Maryland, as most states, athletes are given the “standard recommended physical,” said Ned Sparks, director of the state public high school athletic association. Sparks said a conglomerate of several associations, including the American Medical Society for Sports Medicine and the American Academy of Pediatrics, recommend the physical.
For the last two years, Maryland and other states have used a list of questions recommended by the American Heart Association as part of their preparticipation physical exams for high school athletes. Some of the questions deal with family history and are designed to identify possible high risks for heart abnormalities.
Those questions, along with a new test for Marfan’s syndrome (another cause of sudden death) and more advanced cardiovascular testing, “have all done a pretty good job,” said Dr. Vito Perriello, chairman of the sports medicine advisory committee of the National Federation of State High School Associations.
“All of those are major improvements,” Perriello said. “But there are still a number of sudden deaths in athletes every year, and a number of those end up being undetected, unknown cardiac abnormalities. … There are still youngsters that, had they had the EKG and the echo, it still would not have been identified.”
No test is foolproof or 100 percent definitive. And just because a test reveals nothing one year doesn’t mean something might not occur later on.
“It’s not a guarantee forever,” Salberg said of even the most advanced testing. “It’s a moment in time.”
Perriello still recognizes the value of using advanced equipment.
“That’s where over the last 20 years, the argument or the debate or the judgment call is,” he said. “Is it practical? Is it possible? … Every time there’s a tragedy, this comes up. But even if we did an EKG or an echo on every individual playing sports, we would still not identify every single cardiac death that has occurred in athletic competition.”
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