Thursday, May 19, 2011

Heart Abnormalities the Leading Cause of Sudden Deaths in Athletes

It has been proven beyond much doubt that playing sports and participating in athletics is good for our health.  Unfortunately approximately 200-300 adolescents and young adults die every year from partaking in sporting activities in the United States.  While heat exposure, dehydration and overexertion are common causes, far and away the most common reason is that the person had some previously undiagnosed heart condition.

People can be born with unrecognized heart conditions or acquire them early in life.  “It is fairly easy to miss an underlying heart condition if the doctor is not thinking about the common cardiovascular problems that put young people at risk for sudden death,” says Aaron L. Baggish, MD, who is a staff cardiologist at Massachusetts General Hospital (MGH).  “If the doctor doesn’t ask the right questions and doesn’t perform the right physical exam maneuvers, it can certainly be missed.”

A number of cardiac conditions can lead to sudden deaths in athletes.  “The most common cardiac reason for sudden death is hypertrophic cardiomyopathy, which is like an abnormal thickening of the heart muscle and arrangement of it,” says Oscar Benavidez, MD, chief of the Division of Pediatric Cardiology at MassGeneral Hospital for Children.  “Some people may have serious arrhythmias that may be episodic and others may have obstruction to blood flow from the heart to the body that can be made worse with exercise.”

Benavidez adds that a person could also have coronary artery anomalies, which are abnormalities in the blood supply to the heart itself.  Other less common cardiac conditions that might lead to sudden deaths include connective tissue disorders, which might lead to tears or ruptures within blood vessels after extreme exertion, or Long QT Syndrome, which could lead to arrhythmias and ventricular fibrillation.

There is always a possibility that an individual may have been visiting their pediatrician regularly, and all the right things were done but the condition was undetectable. Many of the cardiac conditions which might lead to sudden deaths in athletes don’t usually develop in a recognizable pattern until individuals hit their adolescence or young adulthood.

“I don’t think that there is any disagreement about the fact that some sort of pre-participation heart screening is recommended, but the debate currently centers around exactly what those recommendations might be,” says Baggish, who is also the associate director of the Cardiovascular Performance Program at MGH, a program tailored to work with athletic patients.  “The American Heart Association and the American College of Cardiology have suggested that at the very least every youngster should go through a sport specific history and physical, which is a 12-step process that includes questions about their medical history, their family’s medical history and then a few physical examination techniques.”

However, those examinations might not be enough.  Baggish’s group did a study on college athletes to show the benefit of screening practices that include the use of a 12-lead electrocardiogram.  The use of an ECG is far from standard but there were a few important findings from their study.  The study results showed that that the incidence of significant cardiac problems is low but that the history and physical exams of athletes were not comprehensive enough to find any underlying symptoms or issues if they did exist.  “In essence, our study showed that the history and physical just missed a lot of important items that the ECG was able to detect,” says Baggish.

In trying to be aware of any underlying cardiac abnormality, family history is quite important.  Both Baggish and Benavidez recommended that people should be aware if there are unexplained sudden deaths in the family, even in a distant cousin or relative.  Any red flags should be brought up with a physician and every parent and child should have a dialog with their pediatrician when the child is planning on participating in sports.  

“We should do everything we can to promote kids playing sports because exercise is one of the cornerstones of healthy living,” says Baggish.  “However doing it safely requires doctors who are thinking about the right ways of screening and protecting young kids so that tragedies can be prevented or at least minimized.”

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