New Guidelines on Frequent Cause of Sudden Death in Athlete

November 12, 2012

New Guidelines on Frequent Cause of Sudden Death in Athlete

A disorder of the heart which affects as many as 600,000 Americans often goes unnoticed and undiagnosed. That is until some athlete or sportsman dies on the playing field. The condition is called hypertrophic cardiomyopathy (HCM) and new guidelines have been introduced to address diagnosis and treatment of the condition.

Bernard J. Gersh, MD, PhD, is a professor of medicine at the Mayo Clinic in Rochester, Minn. and he co-chaired the committee that drafted the new guidelines. He agrees that in many cases it goes unnoticed in everyday life and only reaches the news when a competitor collapses at an event. He says, “It is an important cause of sudden cardiac death during competitive sport, and from that standpoint perhaps is brought to the headlines more frequently”. Gersh then adds, “It’s one of the commonest inherited cardiac diseases, and it probably hasn’t had the attention it’s deserved. I think if you talk to people out there, there’s a great deal of confusion about how to treat this condition”.

Hypertrophic Cardiomyopathy – What is it?

Hypertrophic cardiomyopathy can have symptoms such as chest pain, fainting or dizziness whilst taking exercise. Other indications may be palpitations, shortness of breath or high blood pressure yet in many cases there are no symptoms. It is only after an autopsy that the cause of death is confirmed as hypertrophic cardiomyopathy.

HCM causes the heart’s walls to grow thicker which in turn lowers the efficiency of the lower chambers causing problems when they are trying to fill and pump blood. A further characteristic of HCM is that the electrical impulses that keep the heart’s rhythm steady can become abnormal. Tara Narula, MD, is a cardiologist at Lenox Hill Hospital in New York City and she explains, “Those electrical abnormalities can cause someone to drop dead”.

The Next Step

Most people with diagnosed HCM can expect to live a full and normal life and this is the message that doctors want to send out to the public.

Barry Maron, MD, is director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation. He was also involved in drafting the recommendations and guidelines relating to HCM. And he says, “This disease, once, not that long ago, regarded as mysterious and almost universally associated with poor outcomes is now a highly treatable genetic heart disease”.

The guidelines are jointly published by The American Heart Association and the American College of Cardiology Foundation and are available in the journal Circulation.

Some of the main points within the report include the recommendation that all close relations to a HCM sufferer should be screened because of the hereditary effects of the condition. Additionally patients have access to genetic testing and counseling and children of parents with hypertrophic cardiomyopathy should be regularly screened, about every year to eighteen months because it is common for HCM to come on as the person grows older.

The report also explains that although competitive sports should be avoided low intensity aerobic activities such as hiking or playing golf can be carried out as part of the individual’s normal lifestyle.

Some other recommendations were of a more technical nature such as all patients should be assessed for the likelihood of sudden death and whenever a patient is deemed to be liable to sudden death then implantable defibrillators should be offered.

Other aspects described the tools available to the physician such as drug therapy which can be successful when dealing with chest pain of shortness of breath. Whenever ultrasounds or electrical testing are inconclusive in their diagnosis of HCM, then cardiac magnetic resonance imaging may be used.

Finally if all other options are unsuccessful then surgery must be performed. The surgery removes muscle from the wall of the heart to ease the condition. The guidelines also recommend that those doing the surgery should have performed at least 20 similar procedures or work at a hospital or department dedicated to hypertrophic cardiomyopathy treatment.

The new guidelines received a good reception from cardiologists who have said that the standard of care for HCM sufferers would improve because of them. Narula agrees and says, “This can only be helpful. The fact that this is laying out very clearly not only what drugs are good but how to screen for it, that patients should be genetically counseled — all of the different aspects — they really are pinning down what should be targeted by a cardiologist”.

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