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sudden death / screening / Defib. article


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  • sudden death / screening / Defib. article

    Copyright 2004 The Tennessean
    All Rights Reserved
    The Tennessean

    September 7, 2004 Tuesday 1st Edition


    LENGTH: 1158 words

    HEADLINE: Death on the playing field



    More testing, access to defibrillators could save young lives, doctors say


    Staff Writer

    It happened again last month.

    An apparently healthy student athlete collapsed on the playing field and
    died, leaving family, friends and the community in shock.

    Sadly, sudden death in young athletes isn't unheard of in Middle Tennessee or
    anywhere else.

    "It must happen in this community at least once or twice a year," says Dr.
    Dan Roden, a heart rhythm specialist at Vanderbilt University Medical Center.
    "And as a parent, I can't think of anything that could be worse."

    How - or if - such deaths could be prevented is the subject of a
    long-simmering debate among doctors, athletic departments and parents. There are
    plenty of opinions, but no easy answers.

    Exams can't find everything

    The most recent victim was 14-year-old Bruce Gilley, a Murfreesboro
    cross-country runner. He died of cardiac arrest after finishing a five-mile
    practice run.

    Last year, three student athletes died. Tyler Beasley, a 16-year-old soccer
    player at Davidson Academy, collapsed during practice. Nathan Fuhrman, a
    16-year-old Tullahoma wrestler, succumbed to a heart defect during practice.
    Shalanda Morton, a 15-year-old McGavock High School basketball player, collapsed
    during a game. And in 2002, 16-year-old Chad Franklin, a Chapel Hill, Tenn.,
    football player, collapsed during pre-game warm-ups.

    The sudden death of a young athlete is rare, and researchers estimate the
    death rate is between one in every 100,000 and one in every 300,000 student
    athletes. The most common cause is an undiagnosed heart problem.

    Metro Schools follow Tennessee Secondary School Athletic Association and
    Tennessee Medical Association guidelines, which require that a medical doctor,
    doctor of osteopathy, physician's assistant or certified nurse practitioner take
    a medical history of each prospective athlete.

    Using a questionnaire, the physician or other health professional asks
    questions such as "have you ever passed out during exercise," "have you ever had
    chest pain during or after exercise" and "has anyone in your family died of
    heart problems or a sudden death before the age of 50."

    The students also receive a general physical exam that measures height,
    weight and blood pressure and examines factors such as flexibility and range of

    Scott Brunette, director of athletics and physical education coordinator for
    Metro Schools, says the current preparticipation medical examination is one of
    the most comprehensive he's seen. If the health professional performing the
    screening must refer a student to a doctor for additional testing, parents must
    provide the coach with written evidence that the student has passed a physical
    exam. The second physician also must submit a letter addressing the student's

    But the consensus among Roden and other researchers is that while
    preparticipation evaluations may be well intentioned, their current design makes
    them incapable of detecting the few conditions that can kill.

    What can be done?

    Several things can suddenly and fatally go wrong with the heart. The most
    common cause of sudden death is a condition known as hypertrophic
    cardiomyopathy, in which the heart muscle becomes thickened and doesn't pump
    blood properly.

    A routine physical won't detect it, but an echocardiogram - an ultrasound of
    the heart - can.

    The problem that even advocates for screening acknowledge is that the
    echocardiogram is a far-from-perfect test. It can miss genuine cases of the
    disorder or unnecessarily worry - or possibly end the sports career of - a
    healthy athlete. That's because athletes often have hearts that are larger than
    normal due to their sports training. Doctors consider this condition, known as
    athlete's heart, harmless.

    Other potentially fatal heart problems, such as a heart rhythm defect known
    as long Q-T syndrome, can't be detected with echocardiogram. That condition
    requires an electrocardiogram (known as ECG or EKG) to measure the heart's
    rhythm, and that test doesn't always catch the disorder.

    Dr. Thomas Best, associate professor of orthopedic and family medicine at the
    University of Wisconsin Medical School in Madison, cautions that the extent to
    which these tests can prevent deaths won't be clear until they're implemented
    and their effectiveness studied.

    "It appears that a significant number of these (heart problems) can in fact
    be detected with a combination of an EKG and/or an echocardiogram," says Best,
    who edited an issue of The Clinical Journal of Sport Medicine earlier this year
    devoted to preparticipation evaluations. "But until we do this, we don't know
    for sure."

    Best says an echocardiogram can cost anywhere from $100 to $300. Performing
    an EKG costs only a few dollars, but a team physician or a cardiologist must
    interpret the results.

    Vanderbilt's Roden, a professor of medicine and pharmacology, says the
    benefits of the screenings easily outweigh the cost.

    "There are plenty of things that we do that are more expensive and probably
    save fewer patients' lives than this," he says. "You have to just make a choice
    about whether you want to build another B2 bomber or screen every child in the
    country, because there's no question which one would be cheaper: screening every
    child in the country."

    Roden and Best also believe that greater access to defibrillators, those
    laptop-size emergency devices found at airports and other public places that
    shock the heart back into rhythm, and more CPR training could help save lives.

    Some of the biggest advocates for better screenings and more defibrillators
    are parents such as Yolanda Morton of Hermitage. Her daughter, Shalanda, died
    last year after collapsing during a basketball game.

    An autopsy revealed a cyst that blocked the flow of spinal fluid to her
    brain, but her doctors suspect that a heart rhythm problem killed her. Morton
    says a potentially lifesaving defibrillator wasn't available when her daughter

    Reba Bryant, program specialist in guidance, counseling and health services
    for Metro schools, says that last year the system placed a defibrillator in each
    high school. The location of the defibrillator within the school is at the
    discretion of each principal, she says, and cost is the reason more aren't

    "We don't have money in the budget for more right now," Bryant says. "But it
    's always something to think about."

    Issues of cost don't sway advocates such as Morton. She says she and her
    family have already paid too high a price.

    "Anytime a child goes out for any activity, they need to be tested," Morton
    says. "I have a granddaughter now and she's a newborn, but if she decides to
    play a sport, she's going to get tested no matter what the cost. I'd rather pay
    the price, because money can't replace life."
    Knowledge is power ... Stay informed!
    YOU can make a difference - all you have to do is try!

    Dx age 12 current age 46 and counting!
    lost: 5 family members to HCM (SCD, Stroke, CHF)
    Others diagnosed living with HCM (or gene +) include - daughter, niece, nephew, cousin, sister and many many friends!
    Therapy - ICD (implanted 97, 01, 04 and 11, medication
    Currently not obstructed
    Complications - unnecessary pacemaker and stroke (unrelated to each other)

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