Rare heart conditions a danger to teen athletes--San Francisco Chronicle

Thanks to Junaid Khan, MD, cardiac surgeon at Alta Bates Summit, for his assistance in the following article from today’s San Francisco Chronicle on teenage athletes – and the possibility of undiagnosed cardiac conditions.

Rare heart conditions a danger to teen athletes
Victoria Colliver, Chronicle Staff Writer
Friday, February 5, 2010

The collapse of two teenaged basketball players in less than a week - one of whom died - highlights the fact that even young, seemingly healthy athletes may have hidden defects that can strike with little warning.

Heart specialists acknowledge that it's extremely rare for a young athlete to collapse or die after physical exertion, but say that an undiagnosed cardiac condition is the most likely cause.
"Unfortunately, the first presentation of these diseases can be sudden death, and that's what makes it so vexing of a problem," said Dr. Byron Lee, professor of medicine in UCSF's cardiology division. "Often, there are no warning signs."

The death last Friday of 17-year-old Joshua Ellison, co-captain of El Sobrante's Calvary Christian Academy high school basketball team, was followed Tuesday night by the collapse of a 16-year-old varsity basketball player from El Cerrito High School. The boy, whose name has not been released, remains hospitalized and is in stable condition, according to his coach.

While the cause of the boys' collapses has not been determined, physicians say the most likely culprit is a heart problem, one of the most common being a condition called hypertrophic cardiomyopathy, which causes the heart muscle to thicken and makes it harder to pump blood.

Other common reasons for athletes to collapse include concussions and heat-related illnesses, but those seem less likely in these cases.

The statistics

A study published last year in the journal of the American Heart Association looked at 1,866 U.S. athletes, ages 8 to 39, who either died from or survived sudden cardiac arrest between 1980 and 2006. Of the athletes who died, 56 percent suffered cardiac arrest; about a third of them were attributed to cardiomyopathy.

Blunt trauma to the chest causing structural damage to the heart was the second-most common cause, accounting for 22 percent of deaths. About 4 percent were caused by a chest blow that interrupted the rhythm of the heart, and just 2 percent resulted from heat stroke.

But even cardiac arrest - the most common cause - is so rare that doctors were shocked by the collapse of the two teenage basketball players from the East Bay within four days.

"Leukemia, cancer, motor vehicle accidents - this is infinitesimally smaller compared to those," said Dr. Junaid Khan, a heart surgeon at Alta Bates Summit Medical Center in Oakland. "This is compared to getting struck by lightning."

High school athletes in California must have a physical examination before playing sports. Since 2004, the California Interscholastic Federation, which oversees high school sports, has required athletes to also submit a complete family medical history to their doctors.

Physicians say such information could help prevent tragedy. A heart attack or sudden death of a non-elderly relative could indicate that a more extensive evaluation is needed.

Controversial EKGs

But doctors don't agree whether all young athletes should undergo routine electrocardiogram, or EKG, screenings, which can show signs of cardiomyopathy or other heart conditions that may indicate the need for additional tests.

Khan, president of the East Bay division of the American Heart Association, said mass EKG screenings of student athletes would not only be costly and impractical, but potentially lead to both false positive and negative results. He recommended EKG screenings only for athletes with other risk factors.

Khan said studies show that the incidence of young athlete deaths in the United States is not statistically different than that in Italy, where all professional and amateur athletes are required to undergo EKG testing before they can participate in competitive sports.

But Lee, of UCSF, disagrees. "It's an opportunity to save lives," he said, acknowledging the hassles that false EKG results could cause. "If lives are saved, it seems like a reasonable price to pay."

Physicians also recommend that parents and children be aware of symptoms that could indicate a heart problem. Such symptoms include extreme shortness of breath, dizziness, heart palpations and, most significantly, fainting.

Warning signs, however, can be difficult for young athletes to recognize and easy to ignore.
In a high-profile case, Cal basketball player Tierra Rogers had to give up the sport last year after being diagnosed with another heart condition known to cause sudden death called arrhythmogenic right ventricular dysplasia. She fell ill during a workout in September, but said her only warning signs before that were two episodes of a racing heart and shortness of breath several years earlier.

Dr. Zian Tseng of UCSF, who was part of the medical team who implanted a defibrillator in Rogers to manage her condition, said she was fortunate to have had some warning signs.
"If some of these symptoms were present in these two young victims, there might have been the time for intervention," he said.

One advantage the El Cerrito athlete had was the quick action of the coach and two parents, who administered CPR to the youth.

Physicians say another potentially lifesaving tool would be the increased availability of automated external defibrillators, which use electricity to help the heart re-establish its rhythm.
A proposed state law co-authored by Assemblywoman Mary Hayashi, D-Castro Valley, and Assemblyman Jerry Hill, D-San Mateo, would require that an external defibrillator be available at all high school games and practices.

Sudden cardiac death in young athletes

A study published last year in the journal of the American Heart Association looked at 1,866 young U.S. athletes between 1980 and 2006. Of the deaths:

-- 56 percent were due to cardiovascular disease. A condition called hypertrophic cardiomyopathy, which causes an enlarged heart, is the most common form of the disease.

-- 22 percent were caused by blunt trauma to the chest, which damaged the heart.

-- 4 percent were due to a chest blow that interrupted the heart rhythm.

-- 2 percent were related to heat stroke.

Source: Circulation: Journal of the American Heart Association

Lowering the risk

Here are some of the ways physicians say teenage athletes can reduce the chances for cardiac arrest:

Get a physical with a complete family history
Sudden cardiac arrest in a non-elderly relative is a key part of a family's medical history that may signal a young athlete's need for additional medical screenings such as an EKG.

Be aware of the warning symptoms
Extreme shortness of breath, light headedness, heart palpitations and, in particular, fainting with exertion are signs that warrant immediate attention.

Talk about heeding the signs
Parents should talk with their children about these health symptoms because kids are prone to ignoring the signs, in part because they feel young and invincible. But they also may lack the life experience to know when something is wrong.

Source: Chronicle research.
E-mail Victoria Colliver at vcolliver@sfchornicle.com.
http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/02/05/BABG1BS14N.DTL
This article appeared on page C - 1 of the San Francisco Chronicle


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