African-American players at special risk of death from hypertrophic cardiomyopathy

January 14, 2010- To this day, it still shocks former Dunbar High School basketball coach Bob Wade when he thinks back to June 1993, when he first heard that his star former student, 27-year-old Reggie Lewis, 6’7” and 195 pounds, the top scorer and center for the Boston Celtics, had suddenly collapsed and died during basketball shoot-around.

“Young people are not supposed to die, especially when they are in what we believe to be peak physical form,” says Wade, current coordinator of athletics for the Baltimore City Public School System.  “But as we know now, even top-flight athletes can have hidden heart disease.”

Autopsy results would later confirm that Lewis had an enlarged heart, an inherited defect called hypertrophic cardiomyopathy (HCM), which produced an errant heart rhythm under exercise stress that led to his sudden death. Indeed, Lewis had fainted during a game a few months before, prompting a much-publicized debate on his heart health and foreshadowing his death. But not in time for Lewis to have had an automated defibrillator implanted, a device that can electrically shock the heart back to pumping after it has stopped.

It is in Lewis’ memory that Wade now wants to help other young athletes who may be at risk of sudden death and not know it. 

Wade has lent his support and will join volunteers and heart disease experts from Johns Hopkins in Maryland’s only screening program to detect early signs of life-threatening heart abnormalities in student athletes.  Volunteers will test student athletes during the third annual “Hopkins Heart Hype” screening slated to take place at the 14th annual Basketball Academy Competition.  As many as 300 young athletes from 18 teams, ranging from 14 to 18 years of age, will be examined for HCM.

The Johns Hopkins team of more than 70 includes cardiologists, medical residents, nurses, ultrasound technicians, administrative assistants and community volunteers. They will run a series of heart tests from 10 a.m. to 4 p.m., Saturday, Jan. 16, on athletes who volunteer to be checked in Morgan State's University Student Center.

“Our goal this year is to screen an even larger number of athletes than last year’s event,” says Theodore Abraham, M.D., F.A.C.C., F.A.S.E., a cardiologist and associate professor of medicine in the Division of Cardiology at the Johns Hopkins School of Medicine and director of Johns Hopkins' Hypertrophic Cardiomyopathy Clinic.  Abraham will lead the Hopkins team on Saturday.  “The more we can educate young adults about the risk of sudden cardiac death,” he says “the more we can prevent young athletes from dying unnecessarily.” 

The checkup will include a basic questionnaire to review any past history of chest pain, shortness of breath, fainting spells, instances of sudden cardiac death in relatives, weight and blood pressure measurements, and tests for unusual heartbeats or murmurs.  Each athlete will receive a cardiac ultrasound, or echocardiogram, to measure heart size and its pumping function, including blood volume, and to check for faulty valves. An electrocardiogram, or EKG, to assess the heart’s electrical rhythms will also be given. 

Test results will be reported to each athlete on site, along with recommended follow-ups if problems are detected. 

More than 110,000 high school students in Maryland are active in sports, and, according to Abraham, the stress of athletic competition poses ultra-dangerous risks to those who have inherited tendencies to develop overly enlarged and thickened hearts, hypertrophic cardiomyopathies, or similar abnormalities. 

“These players have a higher than normal risk of sudden, potentially fatal heart rhythm disturbances or cardiac arrest,” he says.  “Young athletes and their parents should feel secure in pursuing physical fitness to the best of their children’s abilities and without the unknown risk of sudden cardiac death.”

Experts estimate that one in 500 Americans has undiagnosed hypertrophic cardiomyopathy.  But African-Americans are more vulnerable, with two to three times the rate of sudden cardiac death than in whites.  Many cases go undiagnosed, Abraham adds, because the young athletes’ healthy appearance and peak physical condition may mask their underlying sickness. 

There are several thousand such sudden deaths per year in younger adults in the United States by some estimates.  “The most frustrating thing is that so many athletes are seemingly unaware about the consequences of putting too much strain on their abnormal cardiac muscle during vigorous exercise,” adds Abraham.

In 2004, the International Olympic Committee recommended that all athletes be EKG-tested every two years for potential heart abnormalities. However, the U.S. Olympic team does not require physical exams for its competing athletes, but instead offers voluntary cardiac screening.

In the last decade, Abraham has treated dozens of athletes with overly enlarged hearts. Their vulnerable condition precluded them from any highly strenuous activity, and the rising number of occurrences is what compelled him to organize the weekend screening. 

“Our goal is to make this not only an annual program in Maryland, but to serve as a model for other programs to start across the country, state by state, city by city, if necessary,” Abraham says, noting that other countries, such as Italy and Japan, have since the early 1980s run regular school programs to screen teenage athletes and non-athletes for possible heart problems.  Health officials in one region of Italy reported that screening had saved at least 22 lives.

Risk reduction strategies to prevent cardiac arrest include avoiding rigorous sports; taking drugs called beta-blockers that temper the heartbeat, preventing it from beating too fast; or implanting defibrillators that can shock the heart back into normal electrical rhythm.

Among the most notable fatalities to date was Lewis, a graduate of Dunbar High School who was also African-American.  Though having collapsed earlier in the year, which weakens, inflames and enlarges the muscle, Lewis continued to play, not fully aware of the danger to his heart.

If there had been better understanding and appreciation for the risks involved with these heart abnormalities, Abraham says, it may have saved the life of Lewis, who’s death was likely triggered by an overly enlarged and thickened heart. 

In Lewis’ honor, his mother, Peggy Rich, has endorsed the “Heart Hype” event and plans to speak at a reception being held the night before.

This year’s event sponsor is Philips Healthcare, based in Andover, Mass. Philips is providing the 20 ultrasound machines and 15 electrocardiographs for EKG screening, plus supplies, needed for the event. The use of Philips equipment for this event does not constitute or imply endorsement by Johns Hopkins of Philips products or services. 

In addition to The Johns Hopkins Hospital and Philips Healthcare, other co-sponsors of this event are Morgan State University, the Maryland Public Secondary Schools Athletic Association, the National Football Foundation, the Hypertrophic Cardiomyopathy Association, Friends in Red, and the Chad Foundation.

For additional information, go to:

http://www.hopkinsheart.org/clinical-services/centers-excellence/center-excellence-hcm.html