Wes Leonard had just made a game-winning layup in overtime,ensuring an undefeated 20-0 season for his high school basketball team. Moments later, the 16-year-old junior collapsed on the gym floor, and the overjoyed shouts of the home crowd at Fennville High School in Michigan quickly turned to stunned horror. He died a short time later at an area hospital. An autopsy report confirmed the cause of death as cardiac arrest due to an enlarged heart.
Leonard’s devastating story made national news because of how and where he died, but that same weekend in March 2011, at least four other high school athletes in towns across the country also died of the same cause.
Sudden cardiac arrest.The words alone are chilling, but even more so when connected with a victim who is barely old enough to drive and, in many cases, even younger.
The facts are sobering. Each year in the U.S., approximately 5 million students compete in athletic events at the high school level. Some sources estimate one student athlete dies from sudden cardiac arrest every three days, with most deaths related to an underlying cardiovascular condition. The American Heart Association reports that, although there are no rock solid numbers, it is believed that approximately one in 200,000 high school-aged athletes die each year from sudden cardiac arrest.
The majority of non-traumatic sudden deaths among athletes are related to pre-existing cardiac abnormalities. Young athletes suffer sudden unexpected death at a rate thought to be two to three times greater than their less-active peers. While exercise itself doesn’t cause cardiac defects, physical exertion can push an already compromised heart beyond what it can endure.
The most common cause (36 percent) of death in young athletes is hypertrophic cardiomyopathy (HCM), a condition that causes thickening of the heart muscle and can lead to heart rhythm disturbances. According to the National Heart Lung and Blood Institute, 1 in 500 children have the condition, and HCM is the leading cause of sudden death in all young people. The second leading cardiovascular cause (17 percent) is congenital coronary artery anomalies.
Sadly, the great majority of teens who suffer sudden cardiac arrest have no idea they have a heart problem. Neither do their families.
Certain factors can predict the likelihood of a teen suffering sudden cardiac arrest due to a genetic defect, as noted in a study published in the Journal of the American Medical Association. Those significant factors include childhood fainting episodes, whether or not the individual was going through puberty and length of the QT interval. (Measured by an electrocardiogram, this refers to the amount of time required for the lower chambers of the heart to electrically reset after each beat).
Males were found to have four times greater risk than females between the ages of 10 and 12. Researchers theorize that hormones associated with puberty may be involved but say that additional research is needed. Overall, the incidence of sudden cardiac arrest tends to be higher in males than females and higher among blacks than whites.
Sudden cardiac arrest typically occurs just as the term implies: suddenly and without warning. The victim collapses and loses consciousness; there is no pulse and no breathing. In some cases, the victim will display some signs before collapse. These may include fatigue, fainting, blackouts, dizziness, chest pain, shortness of breath, weakness, palpitations or vomiting. Unfortunately, in many cases, there are no warning signs.
When someone suffers a heart attack, blood flow to the heart is blocked, although it typically continues beating. With sudden cardiac arrest, the heart actually stops because it develops an abnormal rhythm, known as arrhythmia, which can be fast, slow or irregular.
Once the heart stops beating, time is of the essence. Permanent brain damage or death can occur within four to six minutes. The odds of survival increase if someone at the scene administers cardiopulmonary resuscitation (CPR) and uses a defibrillator to restore normal heart rhythm.
In recent years,automated external defibrillators (AEDs) have made the news because they save lives. AEDs are now found in many public places, such as schools, airports, shopping malls and more. They are present in all Marion County high schools. Each unit costs about $1,200, not including the cabinet.
“In our policy book, it’s recommended that the AEDs are present and available for use at the site of every pre-season and regular season athletic contest,” said Corey Sobers, public relations specialist for the Florida High School Athletic Association (FHSAA). “For postseason, they are mandatory at every event.”
A computerized medical device the size of an average laptop, a standard AED can check a person’s heart rhythm and recognize when a shock is needed. It can be used on any person over age 8.
According to the AHA, the devices are easy to use and extremely accurate. Ideally, you should be trained to use a portable defibrillator, but the device itself utilizes voice prompts and lights to instruct a rescuer.
But just having an AED in a school—or other public place—isn’t enough.
Fennville High School, the school where Wes Leonard collapsed after his game-winning shot, had an AED, but it was not in the gymnasium. Someone ran to get it and brought it to where Leonard lay, but his would-be rescuers then discovered the AED’s battery was dead.
As this case shockingly proved, AED accessibility and maintenance are critical.
“These are life-saving devices, but they don’t work on their own. They only work if people know how to use them and can get to them,” says Martha Lopez Anderson, who founded Saving Young Hearts in 2006.
“An AED should not be installed in a locked office; it has to be publicly accessible. There should be proper signage so people know what it is and where it is, just like water fountains or restrooms,” she adds. “Any time there’s a practice or game, the AED should be on the sidelines.”
Anderson started her Ocoee, Florida-based organization in memory of her son, Sean Alexander Anderson, who died of sudden cardiac arrest while rollerblading in their neighborhood in 2004. By the time paramedics with an AED arrived on the scene 10 minutes later, it was too late. Sean was just 10 years old.
Saving Young Hearts focuses on education, awareness and the placement of AEDs. To date, the organization has donated and placed 68 AEDS in publicschools and other youth-centered locations.
“A lot of people just think this happens to other people and is limited to older or obese people,” Anderson says. “Our job is to let them know that’s not the case.”
Anderson’s foundation also holds heart health screenings, with the next event scheduled for October 20. Although screenings are held in the Orlando area, students from 59 different schools and as far as two hours away attended the last event.
Heat is an obvious culprit in some student athlete tragedies.According to the Florida High School Athletic Association, heat-related illness is the leading cause of preventable death in high school athletes. The FHSAA has updated its guidelines, requiring all member schools to follow “a preseason acclimatization and recovery model for all sports that enhance a student athlete’s well-being.”
Definite steps can be taken to ward off heat-related deaths. These include limiting the duration and intensity of practice during hot weather and making sure students are fit enough to handle practice sessions. However, these precautions may not prevent sudden cardiac arrest.
Corey Sobers of the FHSAA notes that state law requires all student athletes to undergo a pre-participation medical evaluation before the season starts. In addition to a physical exam by a licensed medical practitioner, there is an extensive list of questions to be completed by the parent/student. This list includes such queries as “Have you ever passed out during or after exercise?” and “Has any family member or relative died of heart problems or sudden death before age 50?”
But even if the answers to these and other heart-related questions on the form are “no,” that’s no guarantee of a healthy heart. Even more disturbing is the fact that the majority of cases of sudden cardiac arrest are caused by a pre-existing genetic condition that cannot be detected during a routine physical exam.
However, these life-threatening heart conditions can typically be found through screening tests, such as an electrocardiogram (ECG). Once diagnosed, these conditions can be addressed and the individual can often enjoy a normal lifestyle and life span.
In fact, the American Heart Association (AHA) has announced that “a 12-point screening process could help reduce sudden cardiac death in high school and college competitive athletes.” The process involves a personal history on the student, family history and a physical exam.
If testing is so successful, why aren’t all student athletes tested? After all, screening is required by law in some countries. Italy, for example, requires that all athletes have a mandatory ECG. Students in Japan have an ECG in grades 1, 7 and 10, while all adults over the age of 18 have an ECG every two years. Iceland and Sweden have also begun screening tests on various segments of the population.
According to the AHA, it would cost more than $2 billion per year to conduct mass screenings on the approximate 10 million athletes that compete in the United States each year at the youth, middle school, high school, collegiate, professional and masters (over age 30) level.
Critics say it’s simply not financially feasible, nor practical, to screen all youth athletes.
Darla Varrenti of Seattle disagrees.
“I don’t have a lot of patience for the critics of mandated screening programs. Some of them are calling it rare, but I don’t consider it rare if one child dies of sudden cardiac arrest every two or three days,” says Varrenti, who knows firsthand the grief of losing a child this way.
Her son, Nicholas Dwain Varrenti, was an ardent football player who participated in both varsity and junior varsity games at his high school. Football season was just getting under way, and 16-year-old Nick had put in a week of twice-daily practices when he collapsed and died of sudden cardiac arrest on Labor Day 2004. No one knew he had a congenital heart defect until it was too late.
Critics of mandated mass screenings point out that current tests have a high rate of “false positives,” indicating a problem when none exists. They say the child is then referred for further cardiac testing, which can cost as much as $2,000.
Varrenti says this criticism isn’t adequate.
“The actual amount of ‘false positives’ is much lower than 25 percent, a figure which is commonly given,” she notes. “A lot of the critics are using 10-year-old data as arguments against mandated screenings.”
Nick has been gone for nearly eight years now, but his mother created the Nick of Time Foundation in his honor. The non-profit organization works to increase awareness and educate the public about the need for AEDs in public places. The foundation also helps provide free screening programs for youth athletes. In 2011 and midway through 2012 alone, the foundation has already provided heart screenings for at least 6,000 students in the Seattle area free of charge.
“We do 10 screenings a year and average 400 to 500 kids at each. We do it for free, and it’s completely volunteer-based,” Varrenti explains. “Our medical teams schedule themselves out of their clinics and volunteer for us for the whole day. We have cardiologists reading the ECGs right there in real time. We also ask 10 very specific family-related heart questions.”
Varrenti notes that a surprising number of teens have high blood pressure, which can often be traced to lifestyle choices and even consumption of energy drinks. Any time a child in the screening process has high blood pressure, an echocardiogram is done right away.
“We do find kids at every screening who need follow-up; some of them have already had surgery or a procedure. This isn’t a death sentence and doesn’t always mean the child can’t continue with sports. A lot of the things we find can be fixed. It’s knowing it’s there. Just since Nicky died in 2004, the medical strides made have been amazing,” says Varrenti.
“From January 1 through April 30, 2012, we had reports of 56 kids who had suffered sudden cardiac arrest and only nine survived,” she notes. “During August and September, the numbers (of sudden cardiac arrests) go up dramatically because of school sports programs kicking in.”
Figures of students suffering from sudden cardiac arrest are based on media reports and not every incident is reported. There is no accurate national database and no way to know exactly how many young lives are lost each year to such incidents.
Organizations such as the Nick of Time Foundation and Saving Young Hearts were founded by mothers who have lost children to sudden cardiac arrest. Their efforts continue to focus on education and awareness in hopes of sparing other parents the heartache they’ve endured.
“Parents take kids to get their eyes checked and take them to the dentist, but don’t worry about what their hearts are doing,” says Darla Varrenti. “We’re working hard to get the word out.”
Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy is the most common cause of sudden death in young athletes. The individual may or may not have symptoms. If present, symptoms typically increase with physical exertion. Common symptoms include:
Shortness of breath on exertion
Dizziness
Fainting
Chest pain
Abnormal heart rhythms
Lifesaving CPR
When a stranger collapses in a public place from sudden cardiac arrest, observers may call 911, but be afraid to do anything else. In most cases, this is because bystanders think their actions might make the situation worse. They’re wrong. The truth is that, without emergency help, the victim will die—in mere minutes.
If you happen to be present when someone suffers sudden cardiac arrest, your quick action won’t hurt the victim and could actually save his or her life. First, call 911 immediately and begin “hands-only” CPR.
Using both hands, palms down, one on top of the other, do chest compressions in the center of the chest, about 100 compressions per minute. Push hard and fast. Think of the rate of a fast disco song such as “Stayin’ Alive,” which, when you think about it, is totally appropriate in this situation. Keep performing chest compressions until emergency medical help arrives.
Lives have been saved when observers respond immediately with CPR and use an AED.
Source: American Heart Association
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