Pre-screening of student athletes may prevent sudden cardiac arrest

Medical illustration shows the anatomy of the human heart. (commons.wikimedia.org)

MaryAnne Shults

Dana Hills High School freshman Megan Myers was three-quarters into a cross-country race on Sept 26, 2007, when suddenly, she began to feel nauseous. Later that afternoon, she collapsed and was rushed to Mission Hospital. Less than an hour later, she died of an unknown cause. It would take nearly two months for the coroner’s report to determine her cause of death as “multifocal myocarditis,” an inflammation of heart muscle. Myers was a lifelong athlete with no apparent health problems, and no symptoms of illness.

According to a report issued by the University of Washington’s Department of Family Medicine, sudden cardiac arrest is the leading cause of death in young athletes. The Sudden Death in Young Athletes Registry in the United States has identified approximately 115 cases of SCA per year in young competitive athletes, or about one case of sudden death in organized youth sports every three days in the United States. In Orange County alone, seven student athletes have died in the past 20 months.

“It’s absolutely gut-wrenching that it’s happening right here in our own county,” said Holly Morrell, founder of Heartfelt Cardiac Project in Laguna Beach.

Experts argue that perhaps some of these young lives may have been saved if mandatory pre-screening, including an echocardiogram and electrocardiography, for cardiac anomalies or disease were required. In 1997, the American Heart Association clearly stated that required pre-sports physical exams were inadequate in terms of cardiac evaluation. Congenital heart disease, therefore, is often not discovered until it is too late.

An ECHO is a sonogram of the heart, while the EKG records electrical activity of the heart over a period of 10-15 minutes. ECHOs can provide a three-dimensional real-time imaging while an EKG detects abnormal heartbeats or rhythms (arrhythmias). However, these tests are often not covered by health insurance and an ECHO can be cost prohibitive, often running about $1500, according to Morrell.

At Saddleback College, the athletics department follows the standard guidelines set by the state’s Commission on Athletics for a pre-participation screening exam under the supervision of a licensed medical physician. This examination includes a basic physical examination, orthopedic screening, and a complete family history, according to Brad McReynolds, a certified athletic trainer at Saddleback. This pre-sports exam does not require an EKG or ECHO.

“We make sure our athletes are safe,” McReynolds said. “Our athletic trainers are all state certified in cardiopulmonary resuscitation (CPR) and first aid.” The certification requires continuing education as well.

There is a device available for nonprofessionals, designed to save the life of one suffering a potentially fatal heart attack. An automated external defibrillator, or AED, is a portable device that detects cardiac arrhythmias.

An AEDcan detect a disturbance in the rhythm of the heartbeat and treat it through defibrillation, the application of electric shock therapy, allowing the heart to reestablish an effective rhythm. Certification for use is available through many basic life support and first aid classes.

Dr. Anjan Batra, director of electrophysiology at Children’s Hospital of Orange County said, “Ideally, every student would have his heart screened before participating in athletics.” He added that each campus should have portable defibrillators available.

“We have one AED located in the [McKinney] Theater, one in the Health Science building, and one in Athletics,” said Director of Student Health Services Brenda Frame. “Our patrolling police officers also carry an AED in their vehicles as are they are the first responders to on-campus calls for medical assistance.”

McReynolds said that 40 Saddleback College employees are certified in their use.

While the extent of medical testing remains a topic of debate among health professionals, some organizations have taken action by offering students free or low-cost pre-screening.

Known as the pioneer of cardiac screening of student athletes in 1999, Holly Morrell established Heartfelt Cardiac Project not only to provide free or low-cost cardiac screening to provide early detection of cardiac defects, but also to better educate the public and increase awareness. She dedicates her work to the six family members who have died from hypertrophic cardiomyopathy, for which she has also been diagnosed. HCM is a thickening of the heart muscle.

“Dr. Barry Maron, the director and chief investigator of the Minneapolis Heart Foundation, said that HCM is the number one cause of SCD in young people in the U.S.,” Morrell said.

Heartfelt Cardiac Project provides both EKG and ECHOs for a nominal tax-deductable donation per screening. Funding is provided from individuals, corporations, and grants.

“My goal is to specify donated funds for low-income families, especially in this economy, who want screening but can’t afford even a small donation,” Morrell said.

The year after Myers’ death, Dana Hills Parent-Teacher-Student Association, along with Heartfelt Cardiac Project, started offering the more extensive tests for a $75 donation during the spring athletic physicals. The high school’s PTSA will hold their second annual screening next month (see below).

Further information is available at www.heartfeltcardiacprojects.org. Information about Sudden Cardiac Arrest is available from the Sudden Cardiac Arrest Association at suddencardiacarrest.org or the American Heart Association at www.americanheart.org.

Upcoming screening events offered through Heartfelt Cardiac Projects:
Saturday, April 18, 10 a.m. – 4 p.m.
Sport Performance Institute
2295 Laguna Canyon Road
Laguna Beach, CA 92651
Call to schedule appointments: (949) 464-0860

Saturday, May 9, 9 a.m. – 1 p.m.
Thursday, May 28, 3-7 p.m.
2nd Annual DHHS PTSA Screening
Dana Hills High School
33333 Golden Lantern
Dana Point, CA 92629
(Open to general public)

Call to pre-register and schedule appointments: (949) 494-6575

Video: Screening Athletes for heart problems. Doctor Barry Ramo reveals how certain test can save lives. (YouTube.com, KOAT.com)

Click image to see animation showing a moving echocardiogram; a 3D-loop of a heart viewed from the apex, with the apical part of the ventricles removed and the mitral valve clearly visible. Due to missing data the leaflet of the tricuspid and aortic valve is not clearly visible, but the openings are. To the left are two standard two-dimensional views taken from the 3D dataset. (Ekko)

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