A football quarterback dies of cardiac arrest during practice. A 16-year-old track star collapses at a meet and dies of heart attack. Regardless of the individual details, the headlines are not only tragic but heartbreaking for those left to pick up the pieces. Why do seemingly healthy teenagers and young adults, with no known history of heart disease or apparent risk factors, suddenly die of cardiac arrest during what is an otherwise routine workout?
In most instances, the culprit is hypertrophic cardiomyopathy (HCM), a potentially deadly genetic (inherited) disease which cause abnormal thickening (hypertrophy) of the heart muscle. With few outward warning signs, persons with HCM are often unaware that their heart is working overtime just to pump the blood from point A to point B. Add the high intensity workouts of high school and collegiate athletes to the mix of a heart in overdrive trying to keep up with the demand for more blood and the results can be deadly.
The attention of the American Heart Association (AHA) has issued guidelines calling for screening before participating in competitive sports. The AHA guidelines recommend first-line screening for HCM in the form of a routine physical with a questionnaire geared to identify family history risk factors for HCM. For persons identified at risk, the AHA recommends additional follow-up. In addition, the Hypertrophic Cardiomyopathy Association (HCMA) recommends that all states to follow AHA guidelines for HCM screening of student athletes prior to participation in sports programs. Due to the strain that competitive sports places on the heart muscle (persons with HCM should not participate in competitive sports), the HCMA also recommends that HCM screening be conducted prior to participation in recreational sports programs (i.e. Little League, community leagues, etc.) as well.
It is worth noting that not all health care professionals agree on the level of screening for HCM that our young athletes should receive. For example, the European Society of Cardiology recommends ECGs be used as regular part of pre-participation screening. The International Olympic Committee agrees and promotes the use of ECGs as a part of pre-participation screening as well. Some European countries, such as Italy, also observe very strict pre-participation screening protocols. Even in the United States, some philanthropic organizations such as the Championship Hearts Foundation promote a more vigorous screening for HCM for student athletes and offer free ECG screenings for student athletes in their community.
While death from HCM is rare, the disease itself is not that uncommon, affecting one out of every 500 persons. Since HCM is a genetic disorder, anyone with a family history of HCM should be screened prior to participation in competitive sports. While HCM is typically asymptomatic, in rare instances persons may exhibit the following symptoms: difficulty breathing or shortness of breath, unusual fatigue, fainting, dizziness, and chest pain. Student athletes who present any of these symptoms, particularly during exercise or exertion, should be evaluated for HCM.
Sources:
Hypertrophic Cardiomyopathy, The Mayo Clinic, 25 Mar 2009, http://www.mayoclinic.com/health/hypertrophic-cardiomyopathy/DS00948
Lisa Salberg, Athletic Preparticipation Screening Guidelines, Hypertrophic Cardiomyopathy Association, 26 Feb 2009, http://www.4hcm.org/hcm/diagnosis/40255.html
Sudden cardiac death remains rare in young athletes, 16 Feb 2009, American Heart Association, http://www.newsroom.heart.org/index.php?s=43&item=673
Young Athletes Heart Screening Program, Championship Hearts Foundation, 2010, http://www.championshipheartsfoundation.org/screening-program-story (Note: **Championship Hearts Foundation was formerly known as the Austin Heart Foundation. CHF is a philanthropic activity of the Austin Heart cardiology group.
Lisa Salberg, What Symptoms Does Hypertrophic Cardiomyopathy Cause?, Hypertrophic Cardiomyopathy Association, 06 Jan 2009, http://www.4hcm.org/hcm/symptoms/3055.html