Hidden Heart Problems for College Athletes

March 30, 2009— -- Anthony Cherry was an 18-year-old high school senior when he received the news that he would be given a full football scholarship to North Carolina Central University.

Cherry, who had played football throughout high school, viewed a spot on the Eagles team in the fall of 2007 as the culmination of his hard work and passion for the game during the last four years.

But the summer before he was to embark on his freshman year, Cherry passed out unexpectedly during a workout session in his hometown of Baltimore.

"I didn't tell anybody about it because I thought it was because I hadn't eaten anything all day and thought I was just dehydrated," Cherry said. "I didn't think it was more serious than that."

However, when Cherry arrived at college in July, a routine physical revealed that the fainting spell was a warning sign for a life-threatening heart condition that Cherry never would have guessed he had.

The condition was hypertrophic cardiomyopathy -- a form of heart disease characterized by a thickening of the heart muscles that can reduce the flow of blood to the heart. Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death in young athletes.

Suddenly, Cherry's dreams of attending college and donning an Eagles football jersey were dashed. However, Cherry, now 19, said he understands how fortunate he is to have caught the condition before he began a college football career.

"I could have died," Cherry said. "But I feel fine now."

Many other college athletes may not be as lucky as Cherry was, according to a new study presented Saturday at the American College of Cardiology's Scientific Session in Orlando, Fla.

Researchers from St. Luke's Mid-America Heart Institute in Kansas City, Mo., screened 781 male and female college athletes between the ages of 18 and 21 for heart abnormalities using an electrocardiogram, a test that measures electrical activity in the heart.

They found that about one-third of the college athletes showed signs of heart abnormalities. Moreover, researchers found signs of potential heart disease in about one in 10 of the athletes they screened.

Lead study investigator Dr. Anthony Magalski, medical director of the Athletic Heart Clinic at Saint Luke's, said that these findings are an important contribution in the debate over whether college athletes should be universally prescreened for underlying heart conditions before they can play sports.

"I think our study adds to the information out there about what can be done with incorporating an ECG [electrocardiogram] into preparticipation screening," Magalski said.

No Sure Answer for Heart Risks

However, Magalski also noted that reading the results from an ECG test is a complex and often subjective process, making it difficult to pinpoint life-threatening heart conditions with great accuracy.

"It's important to clarify if you use the ECG as a screening tool and ... if you have an abnormal ECG by standard criteria, that doesn't necessarily mean you have something wrong," Magalski said.

Moreover, Magalski said that not all doctors define an "abnormal" ECG the same way.

"Depending on how you define an abnormal ECG, our study showed that somewhere between 25 [percent] to 50 percent of athletes would have needed further testing on their heart," Magalski said.

Because of the large margin for interpretation on what constitutes an "abnormal" ECG, some experts believe that screening college athletes universally would lead to too many young people undergoing unnecessary further testing -- and more importantly, would put them through unnecessary stress and worry over the possibility of having a life-threatening heart condition.

"Depending on where you decide to set the bar for what an 'abnormal' ECG is, you could generate much more unnecessary testing ? and would impart more worries [for the patients], more concerns [and would] complicate their health records," said Dr. Steve Ommen, professor of medicine and director of Hypertrophic Cardiomyopathy Clinic at the Mayo Clinic in Rochester, Minn.

The American Heart Association's current guidelines on screening competitive athletes for heart conditions reflect Ommen's concerns on universal ECG screening of college athletes. As it stands, the association recommends screening for any and all competitive athletes with a standard physical, a discussion with a doctor about personal and family history and having a doctor listen to your heart for a murmur.

However, the association does not recommend that all competitive athletes undergo prescreening with an ECG.

"What's a little controversial is whether competitive athletes should get a standard ECG," said Dr. Lance Becker, spokesman for the heart association and director of the Center for Resuscitation Science at the University of Pennsylvania. "The AHA [the American Heart Association] does recommend an ECG screening, but it's called a 2A recommendation, meaning it's considered an acceptable and good thing to do but not absolutely required in all cases."

"The typical reason for it being in that category is simply one of lack of research and lack of evidence," Becker said.

According to a study published in the journal Circulation in 1995, you would find one case of hypertrophic cardiomyopathy for about every 500 people screened. Some experts said the prevalence of this disease is simply much too low to justify universal screening.

"Every death is a tragedy, but to find those deaths is [like finding] a needle in a haystack, and ... when looking for a needle in a haystack you find a lot of hay," said Dr. Paul Thompson, chief of cardiology and director of the Preventive Cardiology Program and of Cardiovascular Research at Hartford Hospital in Hartford, Conn.

Other experts cited the enormous cost and manpower required to conduct and interpret all of the ECGs as an argument against universal screening for competitive athletes.

"There are not enough cardiologists nationwide to interpret all of the ECGs that would be required for every high school, high school and collegiate athlete, [and] if these are then interpreted by less skilled internists or family doctors, there will be an increase in false positive and false negative readings," said Dr. Robert Bonow, chief of the Division of Cardiology and co-director of the Bluhm Cardiovascular Institute at the Northwestern Memorial Hospital in Chicago.

"This is why this remains controversial and why the medical societies have not recommended widespread screening beyond family history and heart murmurs on physical exam," Bonow said.

Sidelined, but Not Out of the Game

Because of the screening Cherry underwent before competing with the Eagles, he was able to identify and treat his heart condition before the ticking time bomb exploded.

In November 2007, Cherry underwent surgery to implant an electronic defibrillator that can shock his heart back to a normal rhythm in case it stops beating.

Today, Cherry serves as an assistant coach for his former high school's football team.

"I like it a lot," Cherry said. "It keeps me around the game."

Magalski believes Cherry's story is a perfect example of how prescreening college athletes would be successful in saving young lives across the country.

"I think we've shown that at least in a college situation ... that doing this kind of screening can be done and is pretty successful," Magalski said.