Screenings May Cut Death in Young Athletes

May 27, 2008— -- Fifteen-year-old Devon Hensley had been an athlete for most of his life. He had a physical in November 2007 before the start of baseball season at his high school in Bedford, Ind. His weight, eyes, ears, throat, blood pressure, pulse, and breathing were normal; the doctor at the walk-in clinic cleared him to play.

On April 25, Devon went to practice after school, and spent another hour playing catch with his brother. That night, at 2 a.m., his mother Ericka, who was sleeping nearby, awoke to find him shaking violently.

His parents and paramedics performed CPR, but Devon never woke up. He died that night, and an autopsy later revealed his heart was nearly twice the size a normal 15-year-old's heart should be.

"As a mother ... you just think, how could you not know that something that bad was going on?" Ericka said. "You just don't know."

About one out of every 200,000 high school-aged athletes dies every year, usually during high intensity sports, such as football or basketball. As in Devon's case, the most frequent cause of death is hypertrophic cardiomyopathy, or HCM.

The condition is the most common genetic heart defect; about 500,000 Americans have it. Symptoms can include fainting, chest pain and difficulty keeping up with other kids during physical activity. But most people are unaware that they have the disease. And for some young athletes, the evidence of the condition comes too late.

Screening for Heart Problems

HCM causes the heart muscle to thicken, which makes it harder for the organ to pump blood. Changes in the arrangement of heart muscle cells can also cause rhythm problems that lead to sudden death, usually without prior symptoms.

In 2006, Dr. Theodore Abraham, a cardiologist at Johns Hopkins, helped establish a clinic to treat young athletes who have HCM. Some of his patients had already lost a relative to sudden cardiac death, and many were naïve about the dangers.

"It seems we need to start one step ahead of them seeing me," Abraham said. "I thought community education and awareness would be a good way to go about that."

So, Abraham organized the Hopkins Heart Hype Program, a one-day screening event for young athletes. The first day of screenings took place Saturday at Morgan State University in Baltimore, at the 2008 track and field championship games of the Maryland Public Secondary Schools Athletic Association.

In six hours, about 300 student-athletes underwent 25-minute screenings, including weight and blood pressure measurements, an electrocardiogram, or EKG, to check the heart's electrical activity, and an echocardiogram, or ultrasound of the heart. Nearly 50 volunteer medical students, residents, cardiologists, pediatricians, nurses and technicians performed the analyses.

Doctors found one or two dozen athletes who had potential heart problems, such as elevated blood pressure or slightly thickened hearts, but only one was referred to his doctor for possible HCM.

Rakim Hamilton, 18, received a clean bill of health at the screening, but still plans to continue with regular heart checkups. He was shocked when he heard about sudden cardiac deaths affecting athletes.

"You think that nothing can go wrong if you're eating right and exercising," he said.

The event Saturday was one of several efforts across the nation to institute heart screenings. In 1999, Seaneen Greaves founded A Heart for Sports, a nonprofit organization devoted to the cause. Greaves' husband has HCM, the same disease that took his father's life at age 26 and his grandfather's at age 21.

During the past nine years, A Heart for Sports has helped arrange screenings of more than 10,000 student-athletes across the country. This year, the organization launched Teen Screen America, a program designed to help hospitals arrange screenings.

Greaves encourages parents to get involved as well.

"Take a stance," she said. "Sports physicals are just not adequate enough."

A Signal to Stop

Since he was 6 years old, Anthony Cherry, now 18, had played football and got annual physicals, always with a clean bill of health. In the summer of 2007, he was running through his Pikesville, Md., neighborhood when he became lightheaded, and his body began tingling.

"The next thing I knew I was getting up off the ground," he said.

Initially, he wasn't concerned about fainting. But a month or two later, when he received a football physical at North Carolina Central University, doctors were suspicious. Further tests revealed the reason for the episode -- HCM.

"It was shocking to me," Cherry said about his diagnosis. Though he was disappointed to give up football, he listened to doctors' recommendations and stopped playing.

In November, he had surgery to receive an implantable cardioverter defibrillator, a device that delivers an electrical jolt to the heart when it starts beating irregularly. It's one of the common treatments for HCM, along with medication and stopping sports.

Though he has considered going back to the game, Cherry realizes it's not an option.

"My life is worth more than a sport," he said.

Is Screening Worth It?

Both EKGs and echocardiograms can detect heart problems in young athletes. The American Heart Association does not mandate either, but the organization does encourage a 12-point screening process, including questions about personal and family medical history, and a physical examination of student-athletes.

Dr. Paul Thompson, director of the Athletes' Heart Program at Hartford Hospital in Connecticut, agrees with the AHA's decision to refrain from mandating expensive heart tests. "There's absolutely no data anywhere that shows that screening saves lives," he said.

Abraham agrees that the merits of screening haven't been proven, but hopes that Saturday's clinic will provide valuable information. He and his colleagues at Johns Hopkins plan to follow up with students in three to five years to see whether they properly detected problems.

Thompson, however, is not opposed to the idea of annual sports physicals, performed by a pediatrician. He tells parents who are concerned about their child's heart to find a good doctor.

"I think it's helpful to see someone who has had a fair amount of experience dealing with athletes," he said.