Question of the Week

October 8, 2007


An athlete's sudden death was in the news this past weekend. While the heat was the prime suspect, a more hidden culprit was actually to blame. "An autopsy on the body of a Michigan police officer who died running in Sunday's Chicago Marathon reveals that he had a heart condition. The Cook County medical examiner says Chad Schieber suffered from mitral valve prolapse _ a condition that occurs when one of the heart's valves doesn't work properly. ... The medical examiner's office says Schieber's collapse had nothing to do with yesterday's brutally hot weather."

While such conditions are rare, they are not entirely unknown.

"Doctors have known for years that when a seemingly healthy person dies suddenly, as did former Missouri running back Damien Nash on Feb. 24 [2007], the most common cause is an undetected heart condition. Among those conditions is HCM, which Dr. Keith Mankowitz, director of the Hypertrophic Cardiomyopathy Clinic at Barnes-Jewish Hospital, says is responsible for 36 percent of sudden deaths among athletes younger than 35. ... HCM, which is estimated to be present in 1 in 500 people, according to the New England Journal of Medicine, has been tied to the deaths of many high-profile athletes, including basketball players Hank Gathers and Reggie Lewis, figure skater Sergei Grinkov and several international soccer stars."

While high-profile events (like the record-breaking temperatures at the Chicago Marathon) or high profile athletes (professional athletes that those who follow the sport would know) draw national news coverage, local media coverage often explodes when the death of a high school or college athlete shocks a community.

"When an otherwise superbly-conditioned teenager dies suddenly, a condition called sudden cardiac death is often to blame, say experts. Spotting these cases in pre-athletic medical screenings can be a challenge when there are no prior problems to report."
University of Texas Health Science Center

While some may have no symptoms, others may have symptoms that they did not feel were serious enough to report.

"'Typically the athletes have had symptoms as a warning, but they may have ignored it or assumed that they had just overdone it, over-exerted themselves or become too dehydrated.' ... Reports of sudden death are scary, but parents and students should keep in mind that, despite the media blitz these cases receive, this is an unusual event. It seems that with each tragic loss, the anxiety and fear of children dying of this is elevated exponentially above the actually risk. 'Cardiac conditions with a predisposition to sudden death during or following exercise occur in about 5 of 100,000 participants and sudden death occurs in 0.5 of 100,000 people,' Rao says."
University of Texas Health Science Center

The cases are rare, but when they do strike a community, they bring with them a fear of what might happen.

"Testing athletes' hearts dramatically lowered the rate of sports-related sudden cardiac deaths in Italy, a study suggests, but experts said it was not clear such an effort would have as big a payoff in the United States. There are roughly two dozen sports-related deaths of high school and college students from sudden cardiac arrest in the United States each year. Only a handful of schools require electrocardiogram, or EKG, screening. Since 1982, Italy has required all athletes to get EKGs for hidden heart problems before playing competitive sports, and about 2 percent are disqualified because of heart problems. Researchers from the University of Padua Medical School analyzed trends in sudden deaths from heart problems before and after the program began. They looked at both athletes and non-athletes, ages 12 to 35, in the Veneto region of northeastern Italy between 1979 and 2004. They found that, among athletes, the rate of sudden deaths fell by 89 percent over the 25 year-period. The rate among non-athletes did not change."
University of Connecticut Health Center

With 2% of athletes being disqualified in Italy, and 0.005% of athletes with "a predisposition to sudden death during or following exercise," some see screening all prospective athletes as an expensive undertaking that has the potential to provide false positives and create concerns that can lead to the restriction of activity in a generation that is already fighting obesity at increasing rates. Others see it as a way to catch those with the highest risks and offer them some hope.

"If we're able to identify someone as being at high risk of sudden death, there are preventive options. For example, we can prescribe medications such as beta blockers that affect a person's heart rate. Another option for some, such as those with hypertrophic cardiomyopathy, is an implantable cardioverter-defibrillator (ICD). This is a pager-sized device implanted in your chest like a pacemaker. An ICD continuously monitors your heartbeat. If a life-threatening arrhythmia occurs, the ICD delivers a precisely calibrated electrical shock(s) to restore a normal heart rhythm."

Questions of the Week:
Who should be screened for potential heart conditions? Who should determine if the results of the screening would disqualify a prospective athlete from training and/ or competing, and what should the criteria be? What symptoms should athletes (of all ages) be sure to share with their doctors?

Please email me with any ideas or suggestions.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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