Sudden cardiac arrests stir debate about screening athletes

Published: Friday, May 6 2011 10:00 p.m. MDT

ER Doctor Barry Gardner poses with his bike near his home in Sandy Monday, April 25, 2011. Doctor Gardner suffers from a heart condition that gets worse the more he exercises.

Scott G. Winterton, Deseret News

BRIGHAM CITY — Barry Gardner blamed age and not training hard enough when he started to lose his edge on his racing bike.

"My fix for the problem was to train harder," said Gardner, an emergency room physician at Brigham City Community Hospital.

Unbeknownst to Gardner, his "fix" was putting his life at risk. It wasn't until he woke up in the hospital CAT SCAN machine that he learned his heart was enlarged and that he had suffered a sudden cardiac arrest.

Gardner was diagnosed with hypertrophic cardiomyopathy, a genetic condition in which the heart muscle becomes too thick. Extreme physical activity can trigger a life-threatening arrhythmia in people who have this disorder.

The day of Gardner's cardiac arrest, he had put in a three-hour training run on his stationary bicycle, which was not unusual for someone who had commuted by bike from his home in Sandy to Brigham City once a week — a 160-mile round trip.

Fortunately, Gardner's collapse occurred in a hospital, where members of the hospital staff used an external defibrillator to shock his heart out of ventricular fibrillation or V-FIB into a normal rhythm, saving his life.

"If I hadn't been in the emergency department, if I had been the break room, I wouldn't be here," Gardner told KSL.

Sudden cardiac arrest, when it happens, is almost always deadly. According to estimates, 95 percent of victims who experience SCA die before they reach a hospital or other emergency help.

In March, fans in a Michigan high school gym experienced the collective horror of watching the collapse of a 16-year-old basketball player who had scored the game-winning shot in overtime. Paramedics performed CPR and took the boy to a defibrillator on the court. He was rushed by ambulance to a hospital but was pronounced dead two hours later.

Sudden death in young athletes is relatively rare but has become a growing concern in high school and college athletics.

University of Washington research published in the April 4 online issue of the journal Circulation says sudden cardiac death kills more young athletes in the United States than previously estimated.

An analysis of data from the National Collegiate Athletic Association, insurance claims and news reports revealed that one in 43,770 NCAA athletes suffer cardiac death each year. Previous estimates, which relied almost exclusively on news reports, were as low as one in 300,000.

Given that — and how deadly this condition is — there is considerable debate about an appropriate degree of screening for student athletes. Italy screens all athletes for the condition, and deaths from this condition have dropped by 89 percent there, according to Dr. Max Testa, a Salt Lake sports medicine specialist who was instrumental in developing a nationwide cardiac screening program in Italy.

There, extensive exams are funded by the government. In the United States, there is ongoing debate regarding the cost and effectiveness of the screening. In Utah, some 80,000 to 100,000 students participate in high school sports under the auspices of the Utah High School Activities Association. Widespread screening could conceivably save one or two lives a year, statistically speaking.

"Is the return worth the expenditure? Obviously a life is worth whatever it costs. In reality, are we going to save a lot of lives?" queries Bart Thompson, assistant director of UHSAA.

The association attempts to identify student athletes who may need more extensive screening through its pre-participation questionnaire. UHSAA's Sports Medicine Advisory Committee will attempt to further refine the document during its upcoming spring meeting.