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Although a sudden cardiac death in a competitive student athlete is rare, it has an overwhelming impact on a community when it happens.
“According to medical research, sudden deaths in athletes usually are caused by pre-existing unsuspected cardiovascular disease,” says Palmetto Health Heart Hospital cardiologist Dr. Robert Schulze. “Research shows us that the vast majority of sudden deaths in athletes age 35 and younger are due to various congenital cardiovascular diseases, with hypertrophic cardiomyopathy (HCM) being the single most common cause.”
HCM is a genetic disease in which the muscle mass of the heart’s left ventricle becomes thickened and doesn’t work as well as it should.
Symptoms of HCM include shortness of breath on exertion, dizziness, fainting and chest pain. Not all patients who have HCM show outward symptoms. Lack of symptoms often is the case with young athletes who die suddenly from the disease.
“Not uncommonly, HCM is responsible for sudden cardiac death in young athletes with no symptoms,” Schulze says.“Sudden death frequently occurs during moderate or severe exertion in team sports such as basketball or football. This catastrophic event may be due to the athlete’s already compromised heart muscle being additionally stressed during intense training or competition. Particularly strenuous physical activity can act as a trigger mechanism for generating a potentially lethal abnormal, rapid blood pressure.”
HCM is the most common inherited cardiac disorder that causes sudden death in athletes, occurring in one in every 500 Americans and equally affecting men and women. There is no cure for HCM, but there are therapies that can help relieve the symptoms and decrease the affected muscle mass size—potentially decreasing the risk of sudden cardiac death.
Current medical treatments include beta or calcium channel blocker drugs. Surgical treatment of the obstructive form of HCM is an option in some cases. A therapy called alcohol ablation, which involves injecting alcohol down a small branch of one of the heart’s arteries to the extra heart muscle, also is being used. This procedure damages the abnormally thickened extra heart muscle without having to remove it surgically, thereby improving the pumping function of the heart.
Detecting HCM and other conditions that cause sudden cardiac death in young athletes has become a joint mission of pediatricians and cardiologists.
“Through more detailed health screenings, a physician’s goal is to identify clinically relevant and pre-existing cardiovascular abnormalities, thereby reducing the risks associated with organized sports,” Schulze says.
SCREENING STUDENT ATHLETES
In South Carolina, all public and some private high schools participate in the S.C. High School League. This organization provides the preparticipation physical exam paperwork that student athletes must have completed by a doctor of medicine (M.D.) or doctor of osteopathy (D.O.).
The evaluation form requires the physician to complete a physical exam of the student and to ask the student a series of questions about his/her health. Included in that questionnaire are detailed questions that give the student and parent(s) the opportunity to share not only the student’s heart health history, but also family heart health history.
The physician then has the information needed to determine if your child might suffer from HCM or another cardiac disease. The screening exam is only the first tier of recognition.