Remember the sudden and sad deaths of the well-known young athletes, Boston 
Celtic Reggie Lewis and Olympic figure skater Sergei Grinkov?  Well, these 
were two of the many young folk who can be at serious risk when playing 
sport, because of a genetic disorder that is not all that uncommon among 
young folk, namely HCM (hypertrophic cardiomyopathy ).  The following article 
provides more details:

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http://www.heart1.com/news/mainstory.cfm/69/1

HCM: The Silent Disease Plaguing Young Athletes
Heart1, December 17, 2002 

By Jessica Ross, 
Heart1 Staff

Hypertrophic cardiomyopathy (HCM) causes approximately 200,000 American 
deaths annually, the vast majority occurring in individuals under thirty. In 
recent years, Boston Celtic Reggie Lewis, Olympic figure skater Sergei 
Grinkov, Chad Butrum, and Adam Lemel all tragically died of this so-called 
"silent" disease while engaging in athletic activity. The memory of such 
abrupt loss in young athletes has fueled a growing trend to offer 
echocardiograms to student athletes and provide defibrillators at school 
athletic facilities.

HYPERTROPHIC CARDIOMYOPATHY, a genetic cardiac disease that has a relatively 
high frequency of 1:500 among the general population, is responsible for the 
majority of sudden cardiac deaths in young people. In most patients, HCM 
confers little or no disability, and normal life expectancy. Indeed, it is 
the very assymtomatic nature of the disease that makes it so potentially 
dangerous: the first indication of HCM often comes when an athlete collapses 
on a playing field. 

Generally, the disease is diagnosed by echocardiogram, which can detect the 
characteristic left ventricular wall thickening of the heart. For this 
reason, there has been widespread support for including echocardiograms in 
pre-season health screenings for student athletes. Unfortunately, such 
screenings can cost up to $2000 per athlete, and would ideally need to be 
conducted regularly over the athlete’s career. Moreover, there is very little 
echocardiographic data for adolescent athletes, for whom the risk of sudden 
death from HCM is highest. (Sharma et. al)

Fortuitously, a number of physicians, non-profit organizations, and 
politicians have stepped forward to address this critical void. Notably, the 
Chad Foundation for Athletes and Artists and the Living Heart Foundation have 
joined together in recent years to offer free cardiovascular screening to 
athletes in pilot programs across California, Massachusetts, New York, 
Maryland, and Washington, DC. In the results of one such program, conducted 
on the Columbia University varsity football team, the Living Heart Foundation 
found that "over one-half of these college students had one or more 
abnormalities detected by the … screening process."  The Columbia program 
used an Acuson echocardiography system, which is light, easily portable, and 
capable of a wide variety of echocardiograph applications. 

The Chad and Living Heart Foundation are joined in their mission by a growing 
number of like-minded organizations and individuals nationwide. Texas 
physician Dr. Maxwell Axler alone has screened approximately 600 student 
athletes for a minimal fee of $30. His efforts, using SonoSite 
echocardiograph equipment, have yielded eight abnormal results, of which 
three were considered true positives. (Rundle, Wall Street Journal) Although 
some view the number of false positives sometimes generated by the tests as p
roblematic, to most the opportunity to save even one life is a worthwhile 
effort.

In addition to efforts making echocardiograph screening more affordable, 
studies by Dr. Barry J. Maron of the Minneapolis Heart Institute Foundation 
have served to illuminate the characteristics of a healthy adolescent 
athlete’s heart. Notably, Maron’s study determined that "[t]rained 
adolescent athletes demonstrated greater absolute [left ventricular wall 
thickening] LVWT compared with non-athletes." 

Specifically, the research of Maron and colleagues found that male adolescent 
athletes with LVWT of more than12mm, and female adolescent athletes with more 
than 11mm, constitute the populations at risk for HCM (assuming a non-dilated 
left ventricle). Assisting in this work, data from the Chad and Living Heart 
Foundations will be assembled into the "National Cardiovascular Screening 
Lifestyle Initiative," (NCSLI) designed to collect data on cardiovascular 
research in young people. 

Parallel to the echocardiogram movement, automatic external defibrillators 
(AEDs) are now in place at many school athletic facilities. During a heart 
attack or other cardiac emergency, the heart’s rhythm is dangerously 
disrupted. An AED senses such rhythmic abnormalities, and can restore normal 
function by sending a shock through the victim's chest. By mid-2001, all 
fifty states had enacted defibrillator laws or regulations. Some states, such 
as New York, now require AEDs in their schools. 

Congress has also approved legislation to increase access to defibrillators 
for those living in the rural areas of several states. More recently, in June 
2002, President Bush approved the ADAM Act, which assists in providing 
schools with the equipment and technical guidance to save cardiac arrest 
victims. Cosponsored by Senators Russ Feingold (WI) and Susan Collins (ME), 
the act is patterned after Project ADAM, in memory of Adam Lemel, who 
collapsed and died at a high school basketball game. 

The presence of AEDs at school sites have already saved numerous lives as r
eported in recent media, and will doubtlessly continue to do so. In turn, 
while the ability of organizations such as Chad to fund echocardiograms for 
athletes has been injured by the recent economic downturn, Chad President 
Arista notes that the organization "looks forward to continuing [their] work… 
to help save young lives through screenings." 

Sources:

* "Sudden Death on Sports Field" Wall Street Journal Rhonda L. Rundle 

* JAMA 2002 Mar 13;287(10):1308-20 Hypertrophic cardiomyopathy: a systematic  
review. Maron BJ.  

* J Am Coll Cardiol 2002 Oct 16;40(8):1431-6 Physiologic limits of left 
ventricular  hypertrophy in elite junior athletes: relevance to differential 
diagnosis of athlete’s heart and  hypertrophic cardiomyopathy. Sharma S, 
Maron BJ, Whyte G, Firoozi S, Elliot PM,  McKenna WJ  

* Personal Communication, Arista Star, President & Founder of The Chad 
Foundation for  Athletes and Artists  

* http://www.livingheartfoundation.org/columbiaresults.html  

* http://www.wispolitics.com/freeser/pr/pr0202/Feb8/pr02020806.html   

* http://www.columbia.edu/cu/news/01/08/football_screening.html

* http://www.ncsl.org/programs/health/aed.htm

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Dr Mel C Siff
Denver, USA
[log in to unmask]
http://groups.yahoo.com/group/Supertraining/ (sports science, fitness and 
health forum)