
STORY BYEach start of the new school year, headlines bear the names of a handful of young, seemingly healthy athletes who die suddenly on the basketball court, the football field, or the track.
Already this school year, three Houston-area teen athletes, ranging from 12 to 19 years old have died suddenly during or following athletic workouts. Though one was attributed to an aggressive form of meningitis, the other two were determined to be either from enlarged hearts or fatal arrhythmias.
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. And, though these incidences are tragic beyond measure, physicians urge parents to keep perspective: sudden cardiac death in teens is still rare.
Sudden cardiac death occurs when the heart stops abruptly. In teenagers and young adults, structural heart abnormalities or heart rhythm disturbances are a common cause of sudden death. The condition claims the lives of a few athletes each fall, usually in the beginning of the sports season. And, though physical exertion in Houston heat can create opportunity for other complications, it rarely is the underlying cause of sudden cardiac death.
Newspapers splash headlines and communities are devastated " because it is such an unexpected death in someone who was always thought to be healthy, an athlete," says Dr. Grant Fowler, professor and vice chair in the Department of Family Practice and Community Medicine at The University of Texas Medical School, and certified in primary care sports medicine. "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."
An inherited heart defect called hypertrophic cardiomyopathy is a common cause of sudden cardiac death. In persons with hypertrophic cardiomyopathy, the heart muscle, usually the left ventricle, is abnormally enlarged. The malformed ventricle can block the blood flow and cause abnormal heart rhythms, called arrhythmias. Some arrhythmias (not all) can lead to sudden death.
In athletic teens with normal hearts, the heart muscle, like any other muscle, naturally thickens and enlarges from strenuous exercise so that it can pump more efficiently. “Athlete’s heart” is not a cause of sudden death, says Dr. Syam P. Rao, director of the Division of Pediatric Cardiology at UT Medical School, “but should be distinguished from hypertrophic cardiomyopathy by a cardiologist.”
Marfan syndrome is another inherited disorder that increases risk for sudden death. This connective tissue disorder affects the skeleton, lungs, eyes, heart and blood vessels, and can cause aortic dilations, which can rupture suddenly when the heart is under stress.
People with the syndrome are tall and have unusually long limbs, traits that are often desirable in sports like basketball. However, Marfan teens should avoid all contact sports.
Coronary heart disease, congenital anomalies of the coronary arteries, some rare arrhythmias, aortic aneurysm dissection, myocarditis, long QT syndrome, Kawasaki's disease, and hard blows to the chest are also risk factors for sudden death, Rao explains.
Fainting, chest pain, difficulty breathing and dizziness with exercise can all be warning signs of heart problems and warrant attention. Parents and teenagers should take them seriously, and see a doctor. Better yet, tell your doctor about any problems you may be having, before the season starts, at your annual sports screening. He or she can help determine whether you at risk for heart problems.
Electrocardiogram: Often abbreviated, as EKG
or ECG, the electrocardiogram is a test that shows
the electrical activity of the heartbeat.
Stress electrocardiography: Also called a
"stress
ECG," this test is an electrocardiogram
done before and during or immediately after some
form of physical stress, usually exercise on a
treadmill.
Echocardiogram: An echocardiogram is an
ultrasound of the heart. The test uses sound
waves to shows the shape, texture and
movement of the heart's valves. The test also
shows the size of the heart chambers, muscle
thickness and how well they're working.
Holter monitor: A small, battery-powered
portable machine that records the heart’s rhythms,
usually for a 24-hour period. Small electrodes are
stuck to the chest and attached to a recorder that
stores the information. Patients go about their
activities wearing the monitor over the shoulder or
stashed in a pocket. The physician is able to
capture electrical heart tracings over a long period
of time.
After an initial, thorough physical exam, "I typically have three questions for patients: have they ever passed out when exercising, have they ever had palpitations or felt like they were going to faint while exercising, or is there a family member who has ever died suddenly," Fowler says.
If students answer yes to any of the questions, they may have an underlying heart problem that necessitates additional diagnostic testing. The tests that are selected are based on what is found on the history and physical examination.
Most of the time, the tests are only a precaution and the results reveal nothing wrong. And, not all tests are required for all patients who have cardiac symptoms. But in rare cases, tests uncover a heart abnormality that could be dangerous to a teenager who plays sports.
Taking precautionary measures can help ease the minds of both parents and students concerned about sudden death. When exercising in hot conditions, take frequent water breaks and rest breaks. If you are not feeling well, stop exercising immediately. And don't be afraid that you will look wimpy or weak.
Dr. Rao says that “every child should undergo pre-sports participation screening history and physical examination, performed by the primary care physician or team physician. Routine screening using ECG and echocardiogram are not recommended at this time. If an abnormality is detected by the primary care physician or sports physician during the exam, then referral to a pediatric cardiologist (for patients younger than 18 or 21) or to an adult cardiologist (for patients older than 21) is suggested.”
He says the pediatric cardiologists may then perform an ECG, echocardiogram, have a patient wear a 24-hour Holter monitor (see sidebar), and perform exercise tests or other tests, as necessary.
Rao explains that the statistically low risk of sudden cardiac death in teens “makes assessment of cost-effectiveness of screening methods difficult. The objective is to identify people at risk for sudden death during strenuous exercise in a cost-effective, non-invasive way. Unfortunately we have no universally accepted standards for screening,” Rao says.
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.
UPDATED: 10-04-2006
Dr. Grant Fowler is professor and vice chairman of the Department of Family and Community Medicine at the UT Medical School..
See Dr. Fowler also at:
Dr. Syam Rao is director of the Division of Pediatric Cardiology at the UT Medical School.
Food Irradiation
and Safety
On August 22, 2008, the Food and Drug Administration (FDA) published a final rule that allows the use of irradiation to make fresh iceberg lettuce and fresh spinach safer and last longer without spoiling.
Irradiating fresh iceberg lettuce and spinach will help protect consumers from disease-causing bacteria such as Salmonella and Escherichia coli O157:H7 (E. coli). Illnesses from these bacteria range from uncomfortable symptoms to life-threatening health problems.
The foods affected by the final rule are
Irradiation (also sometimes termed "ionizing radiation") is a process of treating products with a measured dose of radiation. Food irradiation is not new. FDA has conducted irradiation safety evaluations for more than 40 years and has determined the process to be safe for use on a variety of foods.
After studying the safety of irradiating fresh iceberg lettuce and fresh spinach, FDA has determined that these greens, when irradiated under the conditions specified in the final rule, retain their nutrient value and are safe to eat.
FDA considers irradiation a complement to, not a replacement for, proper food-handling by producers, processors, and consumers. Irradiation is just another tool to reduce the levels of disease-causing microorganisms on fresh iceberg lettuce and fresh pinach.
Irradiation does not take the place of washing. FDA continues to recommend that consumers wash fresh and bagged produce before eating unless the packaging specifically states that the product has been pre-washed.
For more information, go to: http://www.fda.gov)