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May 9, 2011
Sudden cardiac arrests stir debate about screening athletes
By Marjorie Cortez
"My fix for the problem was to train harder," said Gardner, an emergency room physician at Brigham City Community Hospital. Unbeknownst to Gardner, his "fix" was putting his life at risk.
It wasn't until he woke up in the hospital CAT SCAN machine that he learned his heart was enlarged and that he had suffered a sudden cardiac arrest. Gardner was diagnosed with hypertrophic cardiomyopathy, a genetic condition in which the heart muscle becomes too thick.
Extreme physical activity can trigger a life-threatening arrhythmia in people who have this disorder. The day of Gardner's cardiac arrest, he had put in a three-hour training run on his stationary bicycle, which was not unusual for someone who had commuted by bike from his home in Sandy to Brigham City once a week — a 160-mile round trip.
Fortunately, Gardner's collapse occurred in a hospital, where members of the hospital staff used an external defibrillator to shock his heart out of ventricular fibrillation or V-FIB into a normal rhythm, saving his life.
"If I hadn't been in the emergency department, if I had been the break room, I wouldn't be here," Gardner told KSL.
Sudden cardiac arrest, when it happens, is almost always deadly. According to estimates, 95 percent of victims who experience SCA die before they reach a hospital or other emergency help.
In March, fans in a Michigan high school gym experienced the collective horror of watching the collapse of a 16-year basketball player who had scored the game-winning shot in overtime.
Sudden death in young athletes is relatively rare but it has become a growing concern in high school and college athletics. University of Washington research published in the April 4 online issue of the journal Circulation says sudden cardiac death kills more young athletes in the United States than previously estimated.
An analysis of data from the National Collegiate Athletic Association, insurance claims and news reports revealed that one in 43,770 NCAA athletes suffer cardiac death each year. Previous estimates, which relied almost exclusively on news reports, were as low as 1 in 300,000.
Given that — and how deadly this condition is — there is considerable debate about an appropriate degree of screening for student athletes.
Italy screens all athletes for the condition and deaths from this condition have dropped by 89 percent, according to Dr. Max Testa, a Salt Lake sports medicine specialist who was instrumental in developing a nationwide cardiac screening program in Italy.
There, extensive exams are funded by the government. In the United States, there is ongoing debate regarding the cost and effectiveness of the screening.
In Utah, some 80,000 to 100,000 students participate in high school sports under the auspices of the Utah High School Activities Association. Widespread screening could conceivably save one or two lives a year, statistically speaking.
"Is the return worth the expenditure? Obviously a life is worth whatever it costs. In reality, are we going to save a lot of lives?" queries Bart Thompson, assistant director of UHSAA.
The association attempts to identify student athletes who may need more extensive screening through its pre-participation questionnaire. UHSAA's Sports Medicine Advisory Committee will attempt to further refine the document during its upcoming spring meeting.
Students are required to complete the questionnaire each year they compete, although the UHSAA requires one physical examination by a health care provider for an athlete's entire high school participation.
That is a baseline requirement. Some schools or school districts require student athletes to undergo physicals every year. Lisa Walker, a certified athletic trainer who is a regional president of the National Athletic Trainers' Association, said she believes physical exams should be conducted each year the athlete competes.
"Just because you didn't have the condition in the ninth grade, doesn't mean you don't have it in the 10th grade," Walker said.
Absent that, more should be done to ensure coaches have up to date training in CPR and schools have automatic external defibrillators available for immediate use. The portable device, which stops cardiac arrhythmia by shocking the heart, can vastly improve the odds of survival if care is administered shortly after the collapse.
The chances of survival decrease 10 percent with every passing minute, which explains why 95 percent of sudden cardiac arrest victims will die on the scene, Walker said.
"I have said that I don't want one until I can have three of them here, one for my bag, one in the gym, one by the little gym. When this happens, emergency medical services can't get there fast enough," Walker said.
Walker said she understands the limits of insurance and screening. Still, she wants to improve the odds for student athletes, both by screening and immediate treatment if they collapse from a heart rhythm disorder.
"None of us wants to be the one to call the parents when it happens," Walker said. As for Gardner, he has had an implantable cardiac defibrillator placed in his chest since his cardiac arrest. It constantly monitors his heart rhythm and can deliver a shock to restore a normal rhythm if his heart develops a dangerous arrhythmia.
He has also modified his exercise regiment to a level that helps him maintain his fitness but does not place him at risk. As for those long bicycle commutes, "I don't do that any more," Gardner said with a grin.