Sudden cardiac arrest is among the leading causes of death among young athletes. A group of local citizens is hoping to change that by informing the public of the danger and what can be done to combat it.
Dr. Lynn Batten recently discussed the topic during a Med School Café lecture on the University of South Alabama campus. Batten, the director of pediatric cardiology at USA, has studied the issue for many years.
“When I was in med school in the 1990s, there were several big-name athletes who died,” she said, referring to Hank Gathers and Reggie Lewis. “Then the American Heart Association published guidelines on the screening of athletes.”
While these suggestions did not include electrocardiogram (EKG) testing for athletes, the International Olympic Committee and European Society of Cardiology both made that recommendation in the mid-2000s. In 2006, Italian doctors published an article showing an 89 percent reduction in SCA among athletes, a figure they attributed to mandated yearly screenings that included an EKG.
The AHA did update its guidelines in 2007 with a list of standardized questions, but again EKG tests were not required. “There are many causes of SCA,” Dr. Batten said. “An EKG will not pick up everything.”
One of the causes that might be identified by EKG abnormalities is hypertrophic cardiomyopathy (HCM), where the heart muscle abnormally thickens. Both Gathers and Lewis were diagnosed with HCM, but each decided to continue playing and eventually died a few months later.
They were not the only stars to be struck by SCA. Pete Maravich, the all-time leading scorer in college basketball, died from coronary artery abnormality. Volleyball star Flo Hyman perished during a game, with the autopsy pointing to an aortic rupture related to Marfan syndrome.
A recent study by the Centers for Disease Control and Prevention linked 2,000 deaths of those less than 25 years old to SCA, while the AHA last year connected 7,000 deaths to those 18 and younger. While a heart attack is caused by “circulation” trouble, SCA is an “electrical” problem.
Dr. Batten said there are reasons why EKG testing has not been fully endorsed. She said there is a 10 to 15 percent false-positive rate, which means an athlete could be disqualified for no reason. She said those results can read as abnormal because of training effects on the heart.
There is also the cost aspect of EKG testing. With the introduction of thousands more tests, a medical professional would have to paid to read the results.
A local nonprofit group that works with Dr. Batten in Mobile and Baldwin counties hopes to address some of these questions.
The Heart For Athletes organization has two main goals: Identify athletes, ages 13 to 18, who are at risk; and make sure people are aware of the signs of SCA, plus instructions on how to respond.
“Two of the biggest things that I would like to get across to coaches, parents and athletes are the warning signs of SCA,” said Amy Cockrell, one of the group’s founders. These include fainting or seizures, shortness of breath, racing heart, dizziness, chest pain or extreme fatigue.
“The fact that if an athlete falls and is unresponsive, the first thought should be SCA, and an AED (automated external defibrillator) should be made available and CPR (cardiopulmonary resuscitation) started.”
Cockrell’s involvement came after her son Sam suffered from a sudden cardiac arrest at the age of 16. A highly competitive triathlete, he collapsed after swimming in a pool in Daphne in May 2013. Fortunately, Dr. Aaron Morgan, a USA family medicine resident, was present and immediately came to his aid.
Sam was diagnosed with arrhythmogenic right ventricular dysplasia, a rare form of cardiomyopathy. He has since received a defibrillator in his chest, takes medicine to control his arrhythmia and adheres to a non-athletic lifestyle.
Still, Sam encountered a second SCA. He has recovered, and is currently a mechanical engineering major at USA.
“Nationwide, if someone suffers from a SCA, they have a 5 percent chance of survival,” Cockrell said. “That number could be higher if people responded appropriately and the cardiac chain of survival (call 911, AED, CPR, early advance care) were implemented.”
The Heart For Athletes group will sponsor its first free heart screening on Saturday, Aug. 16, from 9 a.m. to 4 p.m. USA has not only offered the use of its equipment, but also the clinic space at its campus on Spring Hill Avenue.
There is no charge for athletes ages 13 to 18, but they must register by visiting www.heartforathletes.org or by calling 251-510-7263. The exam will take approximately 30 minutes, and will include an EKG and echocardiogram. A cardiologist on site will review all of the participants’ tests, and result will be given that day.
University staff will also provide CPR and AED training. Dr. Batten said in 2011 that every public middle, junior and senior high school in Alabama was equipped with at least one AED.
“The conditions that lead to SCA are detectable, and deaths are preventable,” Mrs. Cockrell said. “My son’s miraculous survival and recovery were due to the availability of an AED at the scene of his cardiac arrest and quality bystander CPR.”
For more information on future Med School Café talks, call Kim Partridge at 251-460-7770. It is a free lecture series sponsored by the USA Physicians Group.