JANUARY 15, 2006
VOLUME 3 NO. 1

PATIENTS & PRACTICE

Are sports bad for the ticker?

Underlying conditions, doping bring
on athletic heart trouble


On November 21 the Detroit Red Wings' star defenceman Jiri Fischer's heart stopped and he collapsed in convulsions on the bench. Luckily, team physician Dr Tony Colucci and five medics were able to restart his heart with a defibrillator. Mr Fischer is now back on his feet, but the cause of his heart failure has not been disclosed, and it's unclear whether he'll ever return to the ice.

Just weeks earlier, living hockey legend Mario Lemieux was removed from the Pittsburgh Penguin lineup when doctors discovered he had an atrial fibrillation problem, leading many to wonder why so many elite athletes suffer from heart trouble.

WHAT'S ARVD?
In September 2002, Mr Fischer was found to have an abnormally thick heart but cleared to play anyway. Now there's speculation Mr Fischer actually suffers from arrythmogenic right ventricular dysplasia (ARVD), a rare form of cardiomyopathy that disproportionately afflicts young, otherwise healthy athletes. ARVD presents with a range of symptoms that may appear up to 15 years before diagnosis, including palpitations, dizziness and fainting. Excess fatty tissue in the right ventricle leads to increased risk of ventricular arrhythmias and possible sudden cardiac death. Researchers from Johns Hopkins recently published a comprehensive description of the condition in the online edition of Circulation.

"Physicians should be on the lookout for early signs and symptoms [of ARVD] because it's an important cause of sudden cardiac death in healthy young individuals," study author Dr Hugh Calkins told the press. "If a young person faints, especially in association with exercise, their physician should evaluate them carefully for cardiac diseases," added co-author Dr Darshan Dalal. Up to 10 tests are required to confirm an ARVD diagnosis.

DON'T BLAME SPORT
Dr Ian Cohen, the Toronto Argonauts' team physician and an instructor with U of T's Faculty of Physical Education and Health, has seen his share of athletes with heart problems. "Generally the problems weren't attributable to the fact that they were athletes," specified Dr Cohen. He would only worry about sports putting a young athlete's ticker at risk if there's a strong family history of cardiomyopathy. The Johns Hopkins group also concluded that sudden death in competitive athletes is most often due to underlying structural heart disease.

There's nothing new about elite athletes' hearts failing. Legend has it that way back in 490BC, the Greek hero Pheidippides dropped dead upon finishing the 42km run from Marathon to Athens because of "joy in his blood bursting his heart."

Today, performance enhancing drugs surely play a role in at least some of the cases of heart problems in young athletes. "Research evidence shows that up to 50% of NCAA hockey players admit to using ephedrine," said Dr Cohen. "Cardiac arrhythmia and sudden death are well documented in athletes who have taken ephedrine-ephedra for performance enhancement."

 

 

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