Last Thursday, 16-year-old Wes Leonard died shortly after scoring the game-winning shot at his high school basketball game in Michigan. An autopsy found that he had an enlarged heart. Just two days later in Colorado, 17-year-old Matthew Hammerdorfer died after being hit in the chest during a rugby match. He suffered from a congenital heart defect and had previously undergone three heart surgeries.
The two deaths have brought new attention to the dangers of congenital heart defects, and revived an ongoing debate about whether to require heart screening for young athletes.
Congenital heart defects, which affect eight out of every 1,000 newborns, include any problem with the heart’s structure that is present at birth. These defects can prevent normal blood flow through the heart and can cause life-threatening complications, according to Dr. Srihari Naidu, a cardiologist at Winthrop-University Hospital in New York and an expert in hypertrophic cardiomyopathy, a congenital defect in which the heart muscle is unusually thick.
Naidu says that congenital heart defects often go unnoticed because they can exist for years without producing noticeable symptoms. Teens who drop dead while playing sports are often very healthy, high-level athletes.
More wide-spread screening could help identify heart defects early on, Naidu says.
But the questions around screening are complicated, and have no easy answers: Should screening be mandatory for young athletes? What type of screening should be used?
Just this week, for example, a new study found that mandatory ECG screening programs in Italy and Israel had no impact on the number of athlete deaths. Since 1997, Israel has required ECG testing for all athletes. Before the screening requirement, there were about 2.5 deaths per 100,000 athletes each year. After the law, the number was about 2.6 deaths per 100,000, the study found.
Study author Sami Viskin, a cardiologist at Tel Aviv Medical Center, says that while he supports screening efforts, he doesn’t think that making them mandatory is an effective preventative measure. When the tests are mandatory, he says, the cutoff for who is allowed to play sports and who isn’t must be made uniform. Because the test is not perfect, that allows some people with abnormalities to be overlooked and some people who would be able to function normally are prevented from playing.
“Most of the young men who die suddenly have an underlying heart disease, they just don’t know about it. It makes sense to do an electrocardiogram on all of them to look for the disease. The problem is that the abnormality in the electrocardiogram is a very common phenomenon in athletes and only tiny percentage with abnormal electrocardiograms will have problems.” It’s difficult to know where to draw the line.
ECGs are not the only screening tool available to doctors. Naidu says that ultrasound is a more effective screening tool for some types of congenital heart defects.
Connor Gwinn is a junior at James Madison University who would have benefited from an ultrasound. In 2009, he suffered an arrhythmia while running on the track at school. Gwinn immediately went into cardiac arrest, but was extremely lucky that nearby staff were able to resuscitate his heart using an automated external defibrillator. After days in the hospital, doctors discovered that Gwinn suffered from a congenital heart defect.
“We knew it was prevalent in my family,” said Gwinn, “But I had been tested before and it had come up inconclusive.” As Gwinn discovered, the ECGs he had undergone as a child did not detect the defect. Now, he says, doctors monitor his heart through ultrasounds.
Warning signs should also be taken seriously, Naidu says — chest pain, chest pressure, and radiation of pain from the heart can all be indications that the heart is under too much strain.
Heart murmurs, palpitations or a rapid heartbeat when inactive are also red flags.
“Those rapid increases and drops in heart rate typically mean there’s some kind of arrhythmia going on,” said Naidu. In that case, he advises that the child refrain from sports until a doctor is consulted and the problem identified.
Gwinn says having defibrillators and people who know how to operate them at gyms and other sports facilities is also crucial. Although AEDs are often unable to resuscitate people who suffer sudden cardiac arrest they can certainly help, as in Gwinn’s case.
“That’s really what I think is the best thing that we can do right now to combat this,” says Gwinn.
Meanwhile, Naidu is focused on raising awareness and wide-spread screening. He’s participating in a new program on Long Island which provides free ECG screening to high school athletes. Doctors will visit high schools and screen students participating in high risk, high adrenaline sports.
To Gwinn, that makes sense. “If [athletes] think there’s any slight, miniscule reason that they should have a defect, they should definitely get tested.”