STORY BYThe recent sudden death of high school quarterback Reggie Garrett of West-Orange Stark High School, shocked and saddened his friends, family and the community. One minute the fit star quarterback was making a touchdown. The next he collapsed and died. No one saw it coming.
Each 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.
The word is still out on what exactly caused Garrett to die. But when an otherwise superbly-conditioned teenager dies suddenly, a condition called sudden cardiac death is often to blame, say experts.
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 (about 1 in 100,000 students a year), usually in the beginning of the sports season. Although physical exertion in the south Texas 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 Grant Fowler, MD, professor and vice chair in the Department of Family Practice and Community Medicine at The University of Texas Health Science Center at Houston (UTHealth) 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."
Hannah Padilla, 12, looks at the structure
of her heart during her echocardiogram,
an ultrasound of the heart, as part of a
screening test for young athletes.
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 thickened. The malformed ventricle can block the blood flow and cause abnormal heart rhythms, called arrhythmias. Some types of arrhythmias (not all) can lead to sudden death.
In athletic teens with normal hearts, the heart muscle, like any other well-worked muscle, naturally thickens and enlarges from strenuous exercise so that it can pump more efficiently. Not to be confused with hypertrophic cardiomyopathy, this condition, called, “athlete’s heart,” is not a cause of sudden death.
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.
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 your child may be having, before the season starts, at her annual sports screening. Your doctor can help determine your child’s risk for heart problems.
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.
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.
If students answer yes to any of the questions, they may have an underlying heart problem that necessitates additional diagnostic testing by a pediatric cardiologist, such as an EKG and echocardiogram. Most of the time, the tests are only a precaution and the results reveal nothing wrong. But in some cases, these tests uncover dangerous heart abnormalities that a normal physical exam may miss—saving lives in the process.
That’s reason enough to make them a routine part of sports screenings for young athletes, says UTHealth cardiologist John P. Higgins, MD.
“We should add EKG and ECHO to the usual screening for all athletes (as well as non-athletes),” says Higgins, assistant professor of internal medicine at UTHealth Medical School and principal investigator for HEARTS (the Houston Early Age Risk Testing & Screening) study. “Screening by history and physical examination alone are not sufficient to detect many cardiovascular abnormalities in young children associated with sudden cardiac death.”
HEARTS aims to screen 1,500 sixth grade students in the Houston Independent School District for heart conditions. Results of the first HEARTS screening found heart problems in at least 7 percent of the 94 sixth-grade students they screened, using a standardized 20 minute test that included a self-questionnaire, targeted physical, an EKG and limited echocardiogram. The screenings uncovered life-threatening heart conditions in two students.
Current screening guidelines for student athletes don’t include an EKG and echocardiogram, but Higgins and his colleagues with HEARTS hope that will change. Their goals include screening all 12 year-olds in the state for heart problems, introducing a bill in the Texas Senate to reimburse heart screenings, and developing national guidelines for screenings in the United States.
In addition to screening, taking precautionary measures on the field, court, track or pool can help ease the minds of both parents and students concerned about sudden death. When exercising in hot conditions, urge your child to take frequent water breaks and rest breaks. Tell your child to stop exercising immediately if she is not feeling well. Finally, emphasize that taking a break doesn’t make her wimpy or weak. Not every case of sudden death can be prevented, Higgins says, but every effort should be made to make sports safer for our children.
Last Updated: 10-05-2010
The University of Texas Health Science Center at Houston (UTHealth), the most comprehensive academic health center in The UT System and the U.S. Gulf Coast region, is home to schools of biomedical informatics, biomedical sciences, dentistry, medicine, nursing and public health. UTHealth educates more healthcare professionals than any health-related institution in the State of Texas and features the nation’s seventh-largest medical school. It also includes a psychiatric hospital and a growing network of clinics throughout the region. The university’s primary teaching hospitals include Memorial Hermann-Texas Medical Center, Children’s Memorial Hermann Hospital and Lyndon B. Johnson General Hospital. Founded in 1972, UTHealth’s 10,000-plus faculty, staff, students and residents are committed to delivering innovative solutions that create the best hope for a healthier future.
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Dr. Grant Fowler is professor and vice chairman of the Department of Family and Community Medicine at UTHealth Medical School.
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Dr. John Higgins is an assistant professor of medicine at the UTHealth Medical School.
Simple Ways to Help
Young and Old Eyes
May is Healthy Vision Month and it is imperative to take care of eyes whether they’re young or old.
Children should have their vision checked by age 6, even if there aren’t any signs of eye problems. Healthy eyes and vision are very important to a child’s development. Finding and treating eye problems early on can save a child’s sight. Two common eye problems in children are:
Both of these eye problems can be treated if they are found early.
Here are ways to help your child develop vision skills:
Don’t let poor vision put elders at risk. Leave a three-foot, clear path through each room of their house. Outline edges of steps, coffee tables, doorways and bathtubs with colored tape to contrast with surrounding areas. Install lights along outdoor pathways and keep foyers well lit to avoid having to enter dark areas. Replace switch plates with colors that contrast with walls, or outline them with tape of contrasting colors. It is also always smart to use nightlights during the night.
