Tuesday, February 28, 2006

Getting to the heart of athletes' silent killer: Medicine tries to get a grasp on athletes' heart problems

PATRICIA ANSTETT (online@rgj.com)
February 28, 2006

Are athletes engaged in intense training or competitive sports at risk of suddenly dropping dead from heart problems? Highly publicized cases over the years -- the latest involving Detroit Red Wings defenseman Jiri Fischer, 25, whose promising career might have ended after he collapsed on the bench with heart problems during a November game -- have triggered parental and public concern.

They raise these and other questions:
· Who needs to worry about sudden heart death?
· What are the warning signs?
· Should all competitive athletes be screened for heart problems starting in high school?
· What kinds of tests should they undergo?
· Can athletes with serious heart problems be treated and return to active sports?

For players, parents, coaches and fans, we've culled through the research and talked to half a dozen specialists in heart disease and sports medicine. Here is a summary of the problems, the warning signs, the treatments and prevention issues.

The Problems
A range of heart problems can affect athletes. Hypertrophic cardiomyopathy, a disease of the heart muscle that causes it to enlarge and weaken, has gotten the most attention. It is usually hereditary and relatively rare, occurring in one in every 300 to every 500 people. It is the most common cause of sudden heart deaths -- those that occur within one hour of initial symptoms -- among people under age 30 in the United States.

So what happens? Under a microscope, heart muscle cells appear disorganized, not parallel and neatly arranged as they should be. This molecular disorganization, most likely caused by genetic mutations passed along in a family, interrupts transmission of the heart's electrical signals, often causing the heart to beat irregularly.

The most dangerous type is ventricular arrhythmia, which occurs when the heartbeat races to as many as 300 beats a minute, compared with 50 to 80 beats a minute in a normal, resting heart. That's believed to be the type of heartbeat irregularity Fischer experienced when he collapsed and nearly died before he was shocked back to life with a rink-side automatic external defibrillator.

Other things that can cause sudden cardiac death in athletes include high blood pressure, diabetes, high cholesterol, obesity, smoking, inherited diseases such as Marfan's syndrome, heart valve defects and other heart abnormalities, steroids and recreational drugs.

Intense training can trigger a condition called athletic heart syndrome, which causes a thickened heart muscle. Up to now, most experts considered the condition rather harmless. If it does cause problems, they tend to be less dangerous heartbeat irregularities that can be easily fixed with medicine or minimally invasive operations. Detroit Lions quarterback Joey Harrington, for example, underwent such a procedure in March 2003 and later returned to NFL play.

Experts also thought athletic heart syndrome was relatively benign because muscle thickness often reverted to normal once the athlete stopped engaging in intense exercise. Although that often may be true, "it may not be all that simple," says Dr. Archie Roberts, a former NFL quarterback with the Cleveland Browns and Miami Dolphins who became a heart surgeon after his retirement from sports.

Some heart muscles don't automatically reduce in size on retirement from sports, says Roberts, who directs the Living Heart Foundation, a nonprofit New Jersey organization involved with heart disease research. The increasing size of some athletes, the absence of conditioning in retirement and joint pain from lifelong sports activities might limit an athlete's ability to exercise and maintain a heart-healthy lifestyle, he says. "What is apparent physically, like large body size or obesity, may be the tip of the iceberg in retired athletes," Roberts says.

Warning Signs and Testing
Athletes with these signs should see a doctor:
· Family history of heart problems before age 50, particularly sudden heart death.
· Heart murmur detected in an exam.
· High blood pressure.
· Fainting or dizziness.
· Shortness of breath during exercise.
· Diabetes or high cholesterol.

Pre-participation physicals required for high school and college sports vary. Parents and athletes need to take these physicals seriously and report any warning signs to doctors, says Dr. Steven Karageanes, sports medicine specialist for the Henry Ford Health System.

Those showing signs of heart trouble typically undergo a thorough medical history, an electrocardiogram, or EKG, and possibly an echocardiogram, an ultrasound test of the heart. Some countries, notably Italy, require heart screening and EKGs for high school and other athletes, but U.S. experts say that with as many as 15 million people involved with competitive sports, the costs would be too great for the few cases they might detect. Adults who begin sports or intense training at 40 and older also should consider heart screening tests, experts say.

Drugs for heartbeat irregularities might help, but some athletes are reluctant to take the medicines because they fear the medicines decrease performance, doctors say. Athletes with less serious heartbeat irregularities could need a minimally invasive procedure, radiofrequency ablation, to correct the rhythm. It often cures the problem and the athlete no longer needs to take heartbeat medicines.

Implantable internal defibrillators help prevent sudden cardiac death from serious heartbeat irregularity problems, but the American Heart Association, does not recommend that athletes with the devices engage in intense sports because they can misfire or be disconnected during aggressive physical contact.

Athletes who have died from heart-related deaths:
-- Jim Fixx, 51, runner, author, heart attack, 1984
-- Len Bias, 22, all-American college basketball player, cocaine-related heart attack, 1986
-- Pete Maravich, 40, Hall of Fame NBA star, heart attack due to congenital defect, 1988
-- Hank Gathers, 23, Loyola Marymount basketball player, cardiac arrhythmia, 1990
-- Reggie Lewis, 27, Boston Celtics, cardiac arrhythmia, 1993
-- Flo Hyman, 31, Olympic volleyball player, heart attack due to Marfan's syndrome, 1986
-- Florence Griffith Joyner, 38, Olympic track and field athlete, heart seizure, 1998
-- Sergei Grinkov, 28, gold medal-winning Russian pairs skater, early-onset arteriosclerosis, 1995
-- Darryl Kile, 33, St. Louis Cardinals, heart attack due to arteriosclerosis, 2002
-- Sergei Zholtok, 31, Nashville Predators, cardiac arrhythmia, 2004.
-- Jason Collier, 28, Atlanta Hawks, abnormally enlarged heart, 2005.

Athletes diagnosed with heart problems:
-- Robert Traylor, Cleveland Cavaliers. Open-heart surgery for bad aorta in mid-November. Inactive.
-- Juwan Howard, Houston Rockets. Heart infection. Out six months; now active.
-- Eddy Curry, N.Y. Knicks. Heart arrhythmia episode last spring. Refused to take DNA test from Bulls. Active.
-- Joey Harrington, Detroit Lions. Irregular heartbeat in December 2002. Catheter ablation procedure corrected problem.
-- Mario Lemieux, Pittsburgh Penguins. Irregular heartbeat. Retired.
-- Jiri Fischer, Detroit Red Wings. Heart stopped in game Nov. 21. Out indefinitely.
-- Ronny Turiaf, L.A. Lakers. Surgery in July for enlarged aortic root. Inactive.
-- Fred Hoiberg, Minnesota Timberwolves. Surgery in June for enlarged aortic root. Inactive.

Source: Free Press research
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