Wednesday, May 30, 2012

Little League cardiac arrest highlights need for heart screenings

By Dr. Marc Siegel
Published May 29, 2012

Sean Neely, 12, was playing catcher at a little league game in Freeport, Pennsylvania earlier this month when he was hit in the chest with a foul ball. For almost anyone, this would be just a bruise. But for this boy, the thump to the chest came at exactly the most vulnerable moment in the cardiac cycle, sending his heart into a lethal arrhythmia; probably ventricular fibrillation, where the heart quivers and then stops.

The condition where trauma to the chest causes this to happen is known as commotio cordis. It is very rare, and only 15 percent of people who experience it survive. Luckily for Sean, his two coaches initiated Cardio Pulmonary Resuscitation right away (which preserves about 30 percent of cardiac output), and he came around. He was airlifted to Children's Hospital of Phil adelphia, a top notch facility where he was tested and observed for three days, and was reportedly found to have a normal heart. It was a medical miracle that he suffered no damage from the heart stoppage.

Most people who develop this problem require immediate defibrillation; where electric shocks are administered to the chest to restore a normal beat. There are laws to ensure that automated external defibrillators are available in all fifty states, and good Samaritan laws to protect those who use them. They are easy to use; you put the pads on the chest and the defibrillator does the rest - sensing the rhythm and administering a shock if needed. The American Heart Association estimates that AEDs could save 20,000 lives when they are used promptly.
Sean Neely wasn't one of those 20,000 -- the AED wasn't necessary in his case, though one was available on the scene. His heart rhythm returned to normal spontaneously, and the CPR preserved blood flow to Sean's brain and other vital organs until that happened.

Sean's unlucky cardiac arrest wasn't the result of an underlying problem with his heart. Pre-screening by a pediatrician or even a heart specialist could not have predicted this event. Nevertheless, any time a young person sustains a heart attack or arrhythmia while engaging in sports it is a good time to issue a reminder: All teens should see their pediatrician before competing.

I believe these teens should all have at least an EKG as well as a careful physical examination, with special attention paid to their heart sounds and abnormalities on the EKG which might predict an arrhythmia. Any heart murmurs should precipitate an echocardiogram of the heart to make sure there are no problems with the valves or walls of the heart. Any abnormality should immediately be discussed with a cardiologist.

Keep in mind that 100,000 young athletes die of cardiovascular events while participating in sports, which is more than those who die in car accidents. The most common cause is from hypertrophic cardiomyopathy, an abnormal thickening of the wall of the heart that is difficult to diagnose without an echocardiogram.
Sean was lucky; he owes a lot to his coaches and to the two nurses who were on the scene. Others aren't as fortunate - we need to keep a special eye out for heart problems as our teens engage in competitive sports. They are too precious to lose.

Marc Siegel MD is an associate professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a member of the Fox News Medical A Team and author of The Inner Pulse; Unlocking the Secret Code of Sickness and Health.
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