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Athletes and Sudden Cardiac Arrest: A Need for Scrupulous Cardio Testing

“It’s devastating for loved ones because of the pain of loss compounded by shock and surprise” (Garmhausen). That is what one author had to say about sudden cardiac death. Physicians have the responsibility to make the right decisions when diagnosing athletes with heart conditions. However, their proficiency in this area is lacking due to the little testing that is required to allow an athlete to play a sport. Moreover, their “decisions can be impaired insidiously by extrinsic pressures imposed by relatives, fans, alumni, coaching staff, administrators, and other interested parties, particularly when athletes “shop” for multiple medical opinions” (Maron and Pelliccia). One wrong decision made by a physician, though, can cost an athlete his or her life. Physicians must remember that which is the most important part of their job – to keep the lives of their patients (athletes) safe. I understand this all to well. For when I was a sophomore in high school I began to complain about shortness of breath. I went see a physician who then told me that I could never play competitive sports ever again. After many examinations and tests, it was found that I had a heart condition that could potentially lead to sudden cardiac arrest, and furthermore, death. The leading cause of death among competitive athletes, sudden cardiac arrest, is barely accounted for by the annual physical that is required to allow an athlete to play a sport. Therefore, more thorough testing of athletes should be a requirement because otherwise the lives of many athletes are being put at risk unnecessarily.

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Diagnosing athletes with heart conditions of unknown risks is something that has always perplexed doctors. With so much media attention being placed on occasions where athletes drop dead suddenly while playing sports, it is important that doctors make the right decision when identifying which action an athlete should take after a condition is discovered. Richard Pascale, author of Is Sporting Disqualification really necessary?, explains the objective of diagnosing such athletes, saying, “It can be anticipated that with future improvement in the understanding of such diseases and their potential risk of adverse cardiac events associated with intensive sport, the objective should and will be to reduce the number of unnecessary disqualifications and to modulate rather than stop the sports activity of the athlete in question” (Pascale). Sporting disqualification is a worse case scenario as doctors look to diagnose athletes. Once all other options are exhausted, an athlete is then advised to refrain from any intense sports activity. Just like athletes, physicians want athletes to continue to play sports as well.

Nonetheless, a doctor’s true intention is to make a diagnosis for an athlete that doesn’t put his or her life at risk. An issue arises here because little data supports any definitive answer for the proper treatment of athletes who are diagnosed ambiguously. Pascale agrees with this, saying, “The practical management of athletes, however, remains a challenging issue, as little longitudinal data exists supporting the beneficial role of sporting disqualification upon death rates of athletes identified with an inherited cardiac disease” (Pascale). Though little data exists about the treatment of such athletes, it still remains that heart disease is a prevalent issue regarding sports.

According to Adding Electrocardiography to Medical History and Physical Examination for Evaluation Before Sports Participation in College Athletes, “In the United States, estimates are that sudden death occurs in about 1 of every 220,000 young sports participants. Previously unknown heart disease is the leading cause of these deaths” (Baggish, Hutter Jr., Wang, Yarred, Weiner, Kupperman, Picard, Wood). Furthermore, “In pure statistical terms, sudden cardiac arrest afflicts up to 28 high school athletes out of every 100,000” (American Heart Association). Cardiac complications are ever so present in the lives of athletes, and the risks associated with lack of proper physician examination are supported by the facts previously presented.

Not only does a lack of cardio testing put the lives of  athletes at risk, but further information will be provided that exemplifies how pivotal it is that athletes undergo careful examination before being told that they can play a sport safely. Among some of the questions that must be addressed regarding this issue are as follows:

  • What are the issues that physicians face regarding cardio testing?
  • What issues does a lack of testing bring forth?
  • What methods have been proven effective to protect the lives of athletes?
  • How does research portray the necessity for scrupulous testing of athletes?
  • Why is it that exhaustive testing of athletes has not already been implemented as a requirement?

Further supporting my argument, Italy has implemented testing procedures for athletes that has provided substantial results in protecting their lives. My own experiences with cardio testing will also be provided as supporting material. Due to a lack of systemic inspection, multiple cases have been highlighted where athletes have lost their lives. Regardless of what the statistics state, a change in cardio inspections has not been applied to athletes as of yet. The following are all topics that will be discussed throughout the remainder of this paper.

The problem that physicians face regarding athletes is that many athletes are unaware that they have symptoms that could be related to an underlying heart condition, or doesn’t report symptoms. Steve Germhausen from D Magazine would concur, saying, “the possibility of have to leave the football team, or volleyball team, or the track team, some worry, can make athletes keep symptoms to themselves – putting their lives at risk” (Germhausen). In many cases, an athlete’s whole life is consumed by a sport, and not being able to play that sport is something that just isn’t thought about. Furthermore, for the elite athletes of the world, sports are used as a vehicle to a better life. I know that if someone told me that I would never be able to play sports again if I went to the doctor complaining about shortness of breath that I would have avoided the doctor at all costs to continue playing basketball. And, I did avoid the doctor for sometime because I was used to feeling exhausted. The symptoms I had of a heart condition I didn’t even realize were symptoms. Anahad O’Connor explains this issue further, saying, “The problem is that those who are at risk are hard to spot. Warning signs, like dizziness and shortness of breath, can be rare or dismissed by young athletes used to overworking themselves” (O’Connor). In order to make this less of an issue, we need to implement actions that put the control in the hands of physicians, for them to interpret symptoms, and not the athletes themselves.

As of now, the “Current cardiovascular screening strategies, using the American Heart Association (AHA) expert consensus panel recommendations, are lacking across the entire spectrum of sporting, from high school to professional levels” (Evans and White). My conclusion is that improved screening strategies are a necessity because athletes themselves may not even know that they are in danger. However, some athletes may know that they are in danger, yet still choose to play sports anyways. Take, for example, a situation in an article from the American Heart Association about elite athletes that states, “Many such athletes are highly motivated to remain in the competitive arena, may not fully appreciate the implications of the relevant medical information, or are willing to accept the risks while resisting prudent recommendations to withdraw” (Maron and Pelliccia). Athletes, sometimes, are willing to accept the fact that there is a possibility that their life is in danger. But, physicians cannot allow that for that to even be a choice that an athlete has. Nonetheless, the only way to remove this option from situations like these is to make meticulous cardio testing of athletes a prerequisite to participate in sports.

What is being done in Italy should act as a model for the consummate benefits that go along with implementing more detailed cardio testing of athletes. An article titled Preparticipation Screening for Cardiovascular abnormalities in Young Competitive Athletes explains the preparticipation program that has been applied to Italy’s athletes for over 25 years, saying that  “The program, which evaluates several million athletes annually, comprises a history, examination, and electrocardiograph. Athletes with abnormalities on initial evaluation are investigated further and those with potentially serious abnormalities are disqualified” (Papadakis, Whyte, Sharma). This is the type of examination athletes in the United States need to be required to undertake in order to ensure their safety. This type of inspection has attained considerable results as well because “In Italy, sudden cardiac death decreased 90% with such a screening program;” furthermore, “No systematic large studies in the United States have screened all school age children for evidence of conditions that lead to sudden cardiac arrest in children” (Vetter). The results that such examinations have disclosed cannot be denied, yet the United States still refuses to adopt a similar system to preserve the health of its athletes.

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Those in favor of keeping things the way they are, meaning only your annual physical be required to allow an athlete to play a sport, may contend that “Cost is a barrier to the sophisticated tests that can detect conditions that can lead to sudden cardiac arrest. Testing can run into the four-figure range, and is usually not covered by insurance” (Garmhausen) I do agree that it is an issue that insurance does not usually cover such testing because “In contrast to countries such as Italy, national standards linked to mandatory disqualification are not part of the US healthcare system” (Maron and Pelliccia). However, I must reject the claim that follows presented by Garmhausen  saying “Given the cost and the low overall likelihood of sudden cardiac arrest – just one in 1.5 million exercise sessions leads to an episode of heart failure that’s not related to blocked arteries – many argue that blanket testing of athletes doesn’t makes sense” (Garmhausen). The costs do not outweigh the benefits of in-depth testing of athletes. Constantin Muamba, whose youngest brother, Jackson, died in New Jersey due to a heart condition, would agree with me. His take on this issue was that, “If there was a test we could have taken to prevent this and they said it cost $150, we’d have taken it. We had just spent $150 to buy Jackson his sneakers. He only wore them twice. People talk about costs, but we just spent $4,000 on my brother’s funeral” (Rhoden). Money should not be a reason one foregoes testing that could potentially save his or her life. I am sure that if any one was told they could either save thousands of dollars, or save the life of one of their loved ones, that they would choose the latter. It is the understanding that at any point in time when an athlete is playing a sport they could lose their life that the necessity for further testing becomes apparent.

In order to overcome the financial barriers associated with complex testing, institutions have initiated on-site testing of athletes. The Athletic Heart Research Institution first introduced this type of testing in 2005, with its objective being “the provision of accurate, inclusive, and reliable evaluations of an athletes cardiovascular health… to provide reliable data and educated insight to members of the medical community, athletic trainers, coaches, and athletes as to the necessity of cardiovascular testing that supersedes the basic or rudimentary evaluations currently in place for our athletes” (athletic-heart.com). This type of testing is funded by the very institutions that have them, and allows for specialists in cardiovascular disease to look over an athletes current health situation with a keen eye. There are also distinct advantages to on-site testing because they are affordable, convenient, specific for the athletic population, and advanced in technology (athletic-heart.com). Among those institutions that have taken on this kind of program are the University of Florida, University of Georgia, Oklahoma City Thunder, and the Orlando Magic just to name a few. As one can see, not only have colleges begun to understand the importance of intricate cardio testing for athletes, but also those at the most elite level in sports.

Yet, still some physicians may interject on the grounds that “exercise tolerance testing for athletes is counterintuitive in that these individuals routinely perform high-level activity that would stress their cardiovascular system” (Evans and White). Basically, what is being said here is that it is unnecessary that comprehensive testing of athletes be done, yet alone be made a requirement, because most athlete’s cardiovascular systems are undertaking constant stress anyways, and they are fine. I would acknowledge, however, that just because nothing has happened to an athlete yet, does not get rid of the fact that there is, indeed, a possibility that something could happen to them in the future. Take, for instance, the case of Devon Mills, 16, who “had just finished getting a drink of water when he collapsed and died after playing in a [basketball] game for the North Chicago High School freshmen team. The cause of death was an undetected heart problem” (Rhoden). Or look at the case of Joseph Marable, 17, who “collapsed and died during tryouts for the basketball team… Mr. Marable’s doctor said that his signature was forged on the physical form” (Rhoden). This situation only further exemplifies that athletes will do anything they can to keep playing the sports they love, regardless of the risks involved. If anything, it is even more necessary that athletes, whose cardiovascular systems constantly undergo stress, have multifarious testing done to them because they are the ones constantly at risk. Steve Garmhausen from D Magazine puts it best, saying, “Could-be victims who have warning signs should consider themselves lucky. Because it is rare to survive sudden cardiac arrest, heeding them and getting diagnostic tests can be a lifesaver” (Garmhausen). Before one sees exhaustive testing as unnecessary, they should keep in mind that “During a sudden cardiac arrest, the heart is no longer able to pump blood to the rest of the body, and in over 90% of victims, death occurs – abruptly and without warning” (bostonscientific.com).

With thorough cardiac test, the amount of athlete’s that die from sudden cardiac arrest can be decreased significantly, or even better, gotten rid of altogether. Those athletes that die from sudden cardiac arrest “appear to be the healthiest and least vulnerable members of society. In most cases, they’ve shown no prior symptoms and have passed their sports physicals with flying colors” (Garmhausen). It is vitally important that more intricate cardiac testing of athletes be a requirement in order for the “healthiest and least vulnerable members of society” to not only appear that way, but to actually be that way. There have been situations where such investigations of athletes have been proven successful, like that which are being done in Italy. If more elaborate testing remains just a recommendation, athletes who are experiencing symptoms of cardiac problems have the choice of whether they want to disclose that information to physicians or not. In such cases, they may make choices that cost them their lives. Athletes may not always make the right decision to protect themselves, therefore, rules must be instituted to make it so that they don’t have a say in the matter. Karen Schrach is a woman who heads Living for Zachary, an educational organization on why athletes should receive thorough cardiac screening. Her son Zac died from sudden cardiac arrest on the football field. Regarding her devotion to her foundation, she states, “None of these things will bring back my son. But it may prevent the unthinkable from happening to on of Zac’s friends, to someone in the community, or even to a young person I have never met” (Garmhausen). How many mothers are going to have to lose their sons? How many families are going to have to suffer from situations that could have been prevented? How many people’s lives will have to be forever haunted by thoughts of  ‘if only’ and ‘what if’ before a change is made?

Works Consulted

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  • Bostonscientific.com. Boston Scientific Corporation, 2013. Web. 10 Oct. 2018.
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  • Russo, Antonio Dello, Maurizio Pieroni, Pasquale Santangeli, Stefano Bartoletti, Michela Casella, Gemma Pelargonio, Costantino Smaldone, Massimiliano Bianco, Luigi Di Biase, Fulvio Bellocci, Paolo Zeppilli, Cesare Fiorentini, Andrea Natale, Claudio Tondo. “Concealed cardiomyopathies in competitive athletes with ventricular arrhythmias and an apparently normal heart: role of cardiac electroanatomical mapping and biopsy.” Heart Rhythm 8.12 (2011) 1916-1922. Web. 10 Oct. 2018.


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