Knowing the score: Sudden death for athletes often tied to inherited heart condition
Hypertrophic cardiomyopathy can be silent killer for athletes, but if managed well, patients can live active lives, says University of Michigan physician.
Seemingly every year there are reports of a young, apparently healthy athlete dying on the track or playing field.
"As we move into the fall athletic season and with the marathon season approaching we may start to hear about very tragic and sudden deaths among athletes," says Sharlene Day, M.D., assistant professor of internal medicine at the University of Michigan Health System.
"Often athletes feel like they're invincible and they're some of the healthiest members of our society. That's clearly true, but they can also have heart problems and they have to recognize that if something doesn't feel right that they need to pay attention to it and let their physician know."
Most sudden cardiac death in older athletes is related to coronary heart disease. Among younger athletes, however, a leading cause of sudden cardiac death is a genetic heart condition known as hypertrophic cardiomyopathy.
This inherited thickening of the heart muscle is frequently asymptomatic, making it often a silent killer. But proper care can give HCM patients a chance at better quality of life and peace of mind.
"The most important advice that I can give athletes or parents of athletes that are starting out this fall, or older athletes that may be looking towards running a fall marathon, is that they get a good physical examination and history by their primary care physician," says Day, director of the hypertrophic cardiomyopathy clinic at the University of Michigan Cardiovascular Center.
"For younger athletes that should involve a comprehensive pre-participation screening, physical examination and history," she says. "If anything is concerning on either of those they should have further testing."
Typically further testing involves an electrocardiogram, and perhaps even an echocardiogram or an ultrasound of the heart.
About one in 500 people have HCM. The thickening of the heart muscle can cause several different problems, such as the heart muscle can get stiff and make it much harder for the heart to fill with blood every time it beats.
It can cause patients to feel breathless, particularly when they're exerting themselves and sometimes cause pain in their chest that feels like angina.
HCM can lead to abnormal electrical heart rhythms that can result in passing out or in tragic cases – sudden cardiac death.
The University of Michigan has one of only 19 HCM clinics in the nation. It is run by adult and pediatric cardiologists and involves a wide group of specialists including cardiac surgeons, electrophysiologists, a dedicated genetic counselor and a nurse manager who coordinates the program.
Treatment options for HCM are fairly limited. There is no cure and most treatments are aimed at relieving symptoms. Beyond medication, surgery can be an option.
Living with HCM has its restrictions. Those with an established diagnosis of HCM should be restricted from playing virtually all competitive sports, except for golf and other very low level aerobic type sports.
But individuals do not need to be restricted from doing recreational activity.
Timothy Wilkes, 55, Dearborn, Mich., ran his first 5K last fall after suffering a slow decline in his health. He'd known for 15 years that he had the heart condition, but it wasn't until about five years ago that he started to experience symptoms.
"I'd been fairly active and I played softball and basketball but looking back I could tell that when I'd stopped doing those things that it was related to the HCM condition," says Wilkes. "For a while there I wasn't sure if I was just getting old or if it was part of the HCM and it turned out that it was mostly the HCM."
Looking back Wilkes says there were signs of trouble in the family tree – a cousin had heart trouble and his father died from heart problems. Wilkes had heart surgery at the University of Michigan Medical Center in May 2009 and in October participated in his first road race in years.
"Since my surgery I've noticed small, but significant improvements," he says. "I can reach down to pick up something without pausing to relieve dizziness. I can help unload groceries from the car. My wife likes that a lot.
"I participated in my first 5K in years. I didn't win but I ran the entire three miles and I didn't finish last."