David Wilganowski, a 17-year old football star at James Earl Rudder High School in Bryan, Texas, was in the middle of a game when his heart stopped. In cardiac arrest, he staggered toward the sidelines and collapsed.
Fortunately for Wilganowski, the certified athletic trainers who staffed every game at the school jumped into action, performing CPR and restarting his heart with an automated external defibrillator, or AED. By the time paramedics arrived, his heart was pumping again.
He's one of the lucky ones. Though relatively rare, a cardiac event that strikes a young person at practice or play is often deadly. About 100 young people die every year playing organized sports, and cardiac arrest is the cause in half the cases, according to the National Athletic Trainers' Association (NATA).
Dr. Dominic Abrams, a cardiologist at Boston Children's Hospital, said cardiac conditions in young people typically fall into one of two categories.
The first, cardiomyopathies, involve some abnormality of the heart such as enlargement, thinning walls or scaring. The second type is caused by rhythm disturbances. Nothing appears wrong with the heart but it has a tendency to beat irregularly in some way.
In Wilganowski's case, he was diagnosed with a genetic condition known as Long Q-T syndrome. Characterized by rapid heart "quivers" instead of normal rhythm, the heart sometimes stops beating altogether.
Abrams said that at-risk children and young adults can experience a heart event any time but that exercise certainly increases the chances.
"Patients can be at home watching TV when it happens," he said. "But we know that symptoms might be exacerbated during sports because their adrenaline is pumping, causing the heart to beat faster."
High school players of hard driving sports like basketball, football and hockey are not the only ones at risk either -- though their stories are the ones that usually make the news. Abrams referenced a subtype of Long Q-T syndrome that's associated with swimming deaths.
"It's thought to be brought on by the 'diving reflex,' which triggers sudden changes of heart rate and may cause loss of consciousness -- an inherently dangerous occurrence in a pool," he said.
American Heart Association studies show that young black athletes have a greater incidence of cardiovascular death than whites. And a Dutch study in the Journal of American Cardiology found that 68 percent of cardiac arrest cases during sports play were boys.
To Screen or Not to Screen
As Laura Friend said she knows all too well, not every young person who dies from cardiac arrest is a boy or even a competitive athlete.
Her daughter Sarah was a typical active 12-year-old who played sports just for fun. Sarah was at a local water park near their home in North Richland Hills, Texas, taking a lifeguard training class when she lost consciousness.
Ironically, while the course taught CPR and the use of AEDs, Friend said neither was performed on her daughter. It took more than 24 minutes for the ambulance to arrive. She never regained consciousness.
"What was survivable turned into a nightmare," Friend said.
Since her daughter's death, Friend has become an advocate for AED placement and training in schools and says all children should be given "sports physicals," even if they don't participate in competitive sports.
In addition to the usual tests children get in a routine medical checkup, a doctor giving a sports physical will ask the child questions to probe them about cardiac symptoms that might otherwise be missed.
"After her death, two of Sarah's friends told me that she often complained of pain in her chest when she ran," Friend said. "Chest pain during exertion is the number one symptom of cardiac problems in children. If this was discovered, Sarah might have been saved."
Some school districts make sports physicals standard for any child who joins a team. Kids who only play recreational sports, or aren't athletes, aren't usually screened for heart conditions.
More thorough physicals may sound like a good idea, but Abrams said that the practice is controversial because they don't catch many of the hidden dangers that lurk and can yield "false positive" results that might cause a doctor to ban a perfectly healthy athlete from play. They're also time-consuming and expensive.
Increasing Chances of Survival
Secondary prevention, Abrams said, is probably a more realistic approach to saving lives. This includes recognizing an event as it unfolds.
"The athlete may lose consciousness or stagger around for about ten seconds," he said. "They may be dizzy or disoriented or look like they are having a seizure."
Jim Thorton, the president of the National Athletic Trainers' Association, said that having an AED on hand during all athletic events and practice was essential. Just as essential: A staff that's properly trained in lifesaving techniques like CPR and AED use.
"There should be an appropriate, accurate and all-inclusive emergency action plan for every athletic facility and sport," he said. "The staff should know things like who is going to take the lead on initial care, where the AED is and where the ambulance can enter."
Once a cardiac event has occurred, the clock is ticking. The sooner life support can be administered the better. David Wilganowski said that he is acutely aware of that.
"I'm grateful medical help was so readily available. It could have gone a lot worse, so I guess there's a silver lining to everything," he said.