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HEADLINE: CHANGE OF HEART;
LEAVES SWIMMER;ON DECK OF POOL ITALIAN LAW PREVENTS ATHLETE FROM DEFENDING OLYMPIC BREASTROKE
BYLINE: LAURA SPINNEY NATURE NEWS SERVICE
Italy's Domenico Fioravanti won two gold medals at the Sydney Olympics in 2000, for the men's 100-meter and 200-meter breaststroke. But when he goes to Athens this year, it will be as a television commentator, not as a competitor.
His fans will have seen him most recently in the reality TV show "La
Fattoria," or "The Farm." In fact, he hasn't been in a swimming pool at all this year -- though not by choice. In January, the 27-year-old was diagnosed with an inherited heart condition called hypertrophic cardiomyopathy, or HCM, and, under Italian law, he was forced to retire from competitive sport.
Fioravanti suffers from the same genetic problem that killed Cameroonian
soccer player Marc-Vivien Foe in June 2003 while he was playing in the
Confederations Cup semifinal against Colombia, followed seven months later by Hungarian Miklos Feher, who died while playing for Portuguese soccer team Benfica.
Both men died on the pitch -- suddenly, and in front of the cameras. Even
though Fioravanti knows he has the same condition and is well aware of the risks, his family is campaigning for a relaxation of the Italian law. They want him to keep on swimming or at least to have the option.
HCM is the leading cause of sudden death in people under the age of 30. It
is caused by the accumulation of an abnormal protein inside sarcomeres, which
are a basic component of heart muscle cells. This causes the cells to grow too
large and in a shambolic fashion, particularly around the left ventricle. As the
muscles thicken, the heart can develop an irregular beat and runs the risk of
stopping completely. About 0.1 percent to 0.2 percent of the world's population
has HCM. Each year, about 1 percent of these die. The extra strain of excessive
exercise is thought to trigger sudden death in people with the underlying
condition.
Doctors can diagnose HCM through imaging studies, treat it with drugs or
surgery and implant a defibrillator to kick-start the heart back into action
should there be a major problem. But it is still difficult to assess the risk of
sudden death in any given patient. Fioravanti's frustration stems from this
final fact. To all appearances, his condition is mild.
"At this point, I could state that he has a low probability of dying
suddenly, even doing active sport," says Franco Cecchi, the cardiologist at the
University of Florence who confirmed his diagnosis. Yet in Italy, the mere
confirmation of the condition means that Fioravanti is banned from competitive
sport.
In Italy, uniquely, athletes are required by law to get an annual fitness
certificate before being allowed to take part in any competitive event. As part
of this assessment they are given an electrocardiogram, or ECG, and questioned
about their family history. If there is a suspicion of disease, they go on to
have an echocardiogram, or echo -- an ultrasound scan of the heart and valves,
which provides information about muscle thickness and the size of the heart's
chambers. If this shows an abnormality, the athlete is automatically
disqualified -- unless the sport is considered low risk, such as snooker or
archery. If an athlete sneaks through the system and goes on to die while
playing, the doctor who signed the authorizing certificate can be held liable if
found negligent.
Even if the issue of diagnosis can be cracked, it still leaves policy-makers
and athletes with the dilemma of what to do with the information. One case
frequently discussed by doctors concerned about this issue is that of Nicholas
Knapp. A talented 17-year-old basketball player, Knapp had already been offered
a sports scholarship at Northwestern University when his heart stopped at the
end of a game in 1994. He was resuscitated, diagnosed with HCM and surgically
implanted with a defibrillator. Nevertheless, he accepted the sports
scholarship. The university allowed him to keep the scholarship, but barred him
from playing intercollegiate basketball on medical grounds.
A lengthy court battle ensued, in which Knapp argued that the choice was
his, even if by playing he risked death. Northwestern's decision was eventually
upheld, but Knapp was free to enroll in another university's basketball program,
and did so. Three years after his first cardiac arrest, he suffered an episode
of tachyarrhythmia -- an abnormally fast and irregular heartbeat. His
defibrillator discharged, probably preventing a second arrest and saving his
life.
Since Knapp's case, it has been hard for athletes with a known condition to
play competitively in the United States.
But 10 years on, there are still no formal laws to govern these decisions,
only guidelines. HCM patients had to wait until this June for a guide on
participating in recreational sports. The American Heart Association recommends
that people avoid burst activities such as sprinting, and rates the advisability
of different sports for people with different conditions. Swimming is listed as
"probably permitted" for HCM patients -- although this is not meant to apply to
athletes at the Olympic level.
GRAPHIC: Doug Mills/Associated Press
Italian swimmer Domenico Fioravanti, left, celebrates winning the gold medal in
the men's 200-meter breaststroke with teammate Davide Rummolo, who captured the
bronze medal in the 2000 Summer Olympics in Sydney.
LEAVES SWIMMER;ON DECK OF POOL ITALIAN LAW PREVENTS ATHLETE FROM DEFENDING OLYMPIC BREASTROKE
BYLINE: LAURA SPINNEY NATURE NEWS SERVICE
Italy's Domenico Fioravanti won two gold medals at the Sydney Olympics in 2000, for the men's 100-meter and 200-meter breaststroke. But when he goes to Athens this year, it will be as a television commentator, not as a competitor.
His fans will have seen him most recently in the reality TV show "La
Fattoria," or "The Farm." In fact, he hasn't been in a swimming pool at all this year -- though not by choice. In January, the 27-year-old was diagnosed with an inherited heart condition called hypertrophic cardiomyopathy, or HCM, and, under Italian law, he was forced to retire from competitive sport.
Fioravanti suffers from the same genetic problem that killed Cameroonian
soccer player Marc-Vivien Foe in June 2003 while he was playing in the
Confederations Cup semifinal against Colombia, followed seven months later by Hungarian Miklos Feher, who died while playing for Portuguese soccer team Benfica.
Both men died on the pitch -- suddenly, and in front of the cameras. Even
though Fioravanti knows he has the same condition and is well aware of the risks, his family is campaigning for a relaxation of the Italian law. They want him to keep on swimming or at least to have the option.
HCM is the leading cause of sudden death in people under the age of 30. It
is caused by the accumulation of an abnormal protein inside sarcomeres, which
are a basic component of heart muscle cells. This causes the cells to grow too
large and in a shambolic fashion, particularly around the left ventricle. As the
muscles thicken, the heart can develop an irregular beat and runs the risk of
stopping completely. About 0.1 percent to 0.2 percent of the world's population
has HCM. Each year, about 1 percent of these die. The extra strain of excessive
exercise is thought to trigger sudden death in people with the underlying
condition.
Doctors can diagnose HCM through imaging studies, treat it with drugs or
surgery and implant a defibrillator to kick-start the heart back into action
should there be a major problem. But it is still difficult to assess the risk of
sudden death in any given patient. Fioravanti's frustration stems from this
final fact. To all appearances, his condition is mild.
"At this point, I could state that he has a low probability of dying
suddenly, even doing active sport," says Franco Cecchi, the cardiologist at the
University of Florence who confirmed his diagnosis. Yet in Italy, the mere
confirmation of the condition means that Fioravanti is banned from competitive
sport.
In Italy, uniquely, athletes are required by law to get an annual fitness
certificate before being allowed to take part in any competitive event. As part
of this assessment they are given an electrocardiogram, or ECG, and questioned
about their family history. If there is a suspicion of disease, they go on to
have an echocardiogram, or echo -- an ultrasound scan of the heart and valves,
which provides information about muscle thickness and the size of the heart's
chambers. If this shows an abnormality, the athlete is automatically
disqualified -- unless the sport is considered low risk, such as snooker or
archery. If an athlete sneaks through the system and goes on to die while
playing, the doctor who signed the authorizing certificate can be held liable if
found negligent.
Even if the issue of diagnosis can be cracked, it still leaves policy-makers
and athletes with the dilemma of what to do with the information. One case
frequently discussed by doctors concerned about this issue is that of Nicholas
Knapp. A talented 17-year-old basketball player, Knapp had already been offered
a sports scholarship at Northwestern University when his heart stopped at the
end of a game in 1994. He was resuscitated, diagnosed with HCM and surgically
implanted with a defibrillator. Nevertheless, he accepted the sports
scholarship. The university allowed him to keep the scholarship, but barred him
from playing intercollegiate basketball on medical grounds.
A lengthy court battle ensued, in which Knapp argued that the choice was
his, even if by playing he risked death. Northwestern's decision was eventually
upheld, but Knapp was free to enroll in another university's basketball program,
and did so. Three years after his first cardiac arrest, he suffered an episode
of tachyarrhythmia -- an abnormally fast and irregular heartbeat. His
defibrillator discharged, probably preventing a second arrest and saving his
life.
Since Knapp's case, it has been hard for athletes with a known condition to
play competitively in the United States.
But 10 years on, there are still no formal laws to govern these decisions,
only guidelines. HCM patients had to wait until this June for a guide on
participating in recreational sports. The American Heart Association recommends
that people avoid burst activities such as sprinting, and rates the advisability
of different sports for people with different conditions. Swimming is listed as
"probably permitted" for HCM patients -- although this is not meant to apply to
athletes at the Olympic level.
GRAPHIC: Doug Mills/Associated Press
Italian swimmer Domenico Fioravanti, left, celebrates winning the gold medal in
the men's 200-meter breaststroke with teammate Davide Rummolo, who captured the
bronze medal in the 2000 Summer Olympics in Sydney.
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