HEALTH MATTERS: Your health questions answeredQ. As a parent, I was very sorry to hear about the collapse of a high school basketball player during a recent game. What are the possible causes of this, and what can be done to prevent it?
Q. As a parent, I was very sorry to hear about the collapse of a high school basketball player during a recent game. What are the possible causes of this, and what can be done to prevent it?
A. Fortunately, tragic events like this are rare. Given the millions of children and young adults engaged in athletics, only a small number get into such serious health trouble. While I am not involved in the care of this young man, there are four major causes of cardiac arrest that we find in competitive athletes and a dozen or more less common causes.
• The most common cause is an inherited disease called hypertrophic cardiomyopathy. This is an abnormal thickening (or “hypertrophy”) of the wall of the heart that can lead to abnormal heart rhythms, causing collapse during exertion. It occurs in about one out of 500 people.
• A less common cause is called commotio cordis and occurs when a child is hit in the chest, usually with a baseball. The force from the projectile is transmitted through the chest to the heart, causing a heart rhythm disturbance. Once children enter puberty and get their growth spurt, their chests enlarge and this condition becomes less frequent. Another cause is an abnormality of the coronary arteries that run on the surface of the heart and supply it with blood, oxygen and nutrients. In rare cases, the arteries run the wrong way, and lead to the heart not getting enough blood.
• The last of the “common” causes is myocarditis, or an infection of the heart itself, typically caused by a virus. In addition to these four, there are a variety of less common causes, including several forms of congenital heart disease, meaning the heart is abnormal due to problems as it formed during development of the child in the uterus.
As far as prevention, the problem is that we’re looking for the proverbial needle in a haystack, trying to identify a rare problem in a large number of otherwise apparently healthy athletes.
The best screening is to have all athletes undergo a pre-competition medical evaluation, with a complete history and physical examination. The history should look in particular for any problems in other family members, since many of the diseases of concern tend to run in families, as well as look for any symptoms in the athlete, especially shortness of breath, chest pain, lightheadedness or fainting. If there is anything worrisome in the history or physical examination, we’d ordinarily order an electrocardiogram (a recording of the electrical activity of the heart) and an echocardiogram or ultrasound of the heart to look for any structural abnormalities.
The other preventive measure we recommend at competitive athletic events is to have an automatic external defibrillator(or AED available on the sidelines, just in case. This device can “shock” the heart rhythm disturbance back to normal. An AED requires minimal training to use, and its use can truly be lifesaving.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.
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