Athletes = Heart Problems?

It’s all over the news, sports players collapsing while playing.  Just recently Hockey Player Brett MacLean had a cardiac emergency.

While the risk of sudden cardiac arrest is real in all populations, for athletes, it turns out, the risk is three times greater than with their sedentary counterparts.

You would intuitively think athletes would be at a lower level of risk for sudden cardiac arrest but the issue lies not with the physical fitness of a person but in not knowing. Not knowing you are at risk is the main concern here, if you begin playing sport at a high level unaware of a physical or hereditary heart condition that is where the danger lies. Not knowing of an existing condition puts those who are predisposed to heart issues in the danger zone.  But when you put the two together, not knowing and high intensity sport, it’s a recipe for potential disaster and its happening more than you would think.

In a recent interview with Darla Varrenti, executive director of the Nick of Time Foundation it was brought to our attention that in the first two months of this year there were 29 cases of cardiac arrest in young athletes in the U.S…..only four survived.

Ms.Varrenti formed the Nick of Time Foundation after her son Nick died in his sleep after playing a high school football game. He was 16 years old. Through the Nick of Time Foundation she has been passionate about raising the awareness of sudden cardiac arrest and has been an advocate of free screenings for student athletes. “No family should have to go through what we have”.

She also noted that this condition only gets real attention when it happens to elite athletes as it did with star soccer player Fabrice Muamba who was effectively dead for over an hour and survived only after fifteen defibrillator shocks.

There was also the beautiful marathoner Claire Squires who passed away during the London Marathon after suffering a cardiac arrest. Her death was the tenth since the marathon began in 1981, five of the ten were due to heart conditions the runners were unaware of.

Italian footballer Piermario Morosini died of a heart attack during a match in Livorno. And, Norwegian swim champion Alexander Dale Oen died suddenly of cardiac arrest at a training camp inArizona less than a year after standing on the podium at the world championships. Dale Oen was one ofNorway’s biggest medal hopefuls for theLondon games.

The symptoms are elusive and undetectable at times. They can also be readily explained as a result of the exertion that goes along with high intensity sports. Dizziness, shortness of breath and tightness in the chest, athletes can be fooled into thinking they are experiencing the effects of their hard work rather than symptoms of a heart condition.

At the start of each season training camps in all sports open with player physicals. A gruelling day of poking, prodding, blood and urine samples, dental and eye exams, the sometimes painful orthopeadic exam, psychological and mental evaluations and of course the physical testing of everything from the flexibility of your hamstrings to the efficiency of oxygen uptake  in your blood.

All of this in an effort to be pro-active in identifying risk factors that may increase the risk of injury or impact sport performance.

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At the highest levels of sport where hundreds of millions of dollars are on the table, teams will spare no expense to get as detailed as possible when it comes to screening for player health. But what about at the lower levels of sport, high school and college aged sport where getting a good ball to play with is sometimes a challenge?

Well, the risks go up….way up, the effort and intensity levels of sport at these levels do not change, in fact the intensity levels here can be much higher than we would see in professional sport but at the high school and college levels of sport the resources to support player health screening are greatly limited.

So organizations do what they can, maybe some physical testing like a vertical jump for power or a beep test to evaluate cardiovascular performance maybe getting a family doctors note for participation but should we be doing more?

Should we be more concerned about player health in sport and should we be paying heed to the warning signals we are getting from the statistics regarding heart health and young athletes?

Knowing is power and a physical exam is something to seriously consider prior to a competitive season. If your team or sport organization does not include a heart screen in their testing protocols it is certainly worthy of a conversation.

Its here that another issues arises, what is a good protocol for heart screening? There seems to be very little agreement on what the screening method should look like and thus there are no true standardized protocols in place.

In a 2011 article published by the American Medical Association (AMA) it was noted that there is a push by the medical community to consider electrocardiograms and echocardiograms in the screening process for young athletes while some physicians argue that the priority should first be to create and implement a standardized screening and reporting system. Either way, there is a serious lack of agreed upon protocols for heart screening.

The AMA expressed further concern at anOrlandoconference where it was presented that in a pool of surveyed doctors fewer than 50% of physicians were aware that the American Heart Association has a 12 point sudden cardiac arrest screening guideline protocol and only 6% followed them completely. Now, let it be known that doctors are constantly seeking out and learning new protocols, strategies and systems to better care for patients while at the same time being constantly bombarded with information. It’s a challenge to get information into the hands of medical practitioners especially if there is no officially recognized protocol in place.

In 1996 The American Heart Association (AHA) outlined a 12 point sudden cardiac death screening guideline to be used in conjunction with listening to the heart and blood pressure testing which they hoped would become the standard screening procedure for the industry.

The American Heart Association (AHA) 12 point sudden cardiac death screening guidelines:

Personal History

1. Exertional chest pain/discomfort

2. Unexplained syncope/near syncope

3. Excessive exertional and unexplained dyspnea/fatigue associated with exercise

4. Prior recognition of a heart murmur

5. Elevated systemic blood pressure

Family History

6. Premature death (sudden and unexpected or otherwise) before 50 y of age resulting from heart disease in ≥1 relative

7. Disability from heart disease in a close relative <50 y of age

8. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long-QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias

Physical Examination

9. Heart murmur

10. Femoral pulses to exclude aortic coarctation

11. Physical stigmata of Marfan syndrome

12. Brachial artery blood pressure (sitting position)

The issue with the 12 point screen, it seems, has been that the protocols are not well known and now concern that it may not be thorough enough in minimizing the risk factors for young athletes.

Currently there is a very strong push for the standardization of electrocardiograms (EKG) and echocardiograms (echo) in the heart screening process. Technology has always pushed the medical industry forward but there are two outstanding issues with the EKG and Echo, first the accuracy of these tests especially if they are not read correctly and second, the cost of doing the tests.

It turns out that the accuracy concerns are minimal as the technology advances the accuracy has improved quite dramatically and we now have more doctors and specialists who focus on reading the tests and forming proper opinions from the data. As for the cost of an EKG, its right around $90.00 US per test not so out of reach cost wise considering the issue at hand.

The collective and more recent thinking reflects that neither the AHA 12-point screen by itself or a singular EKG or Echo to being the sole answer but a combination of both that provides health care workers the best information for reducing risk factors in sport.

It’s my feeling that heart screening should be part of a regular pre competition screening for athletes and that day is approaching where it will be widely accepted as a standard procedure. But you don’t have to wait, if you are concerned about a heart screen for your young athlete talk with your family doctor and open up the conversation.

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