Sudden cardiac arrest usually strikes without warning, and is fatal in a majority of cases. A leading cause of death in adults over 40, SCA is relatively rare in children and young adults — though its incidence still isn’t negligible.
"It’s estimated that in the United States, once every three days, a student athlete will have a sudden event and die," said Dr. Anthony Rossi, the director of sports cardiology at Miami Children’s Hospital.
SCA in young people is usually caused by hypertrophic cardiomyopathy — a thickening of the heart muscle — or electrical abnormalities in the heart, like the Long Q-T or Wolff-Parkinson-White syndromes, Rossi said.
And while student athletes are required to pass a physical before playing, those conditions can’t be detected in a traditional physical.
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Luckily for South Florida athletes, Miami Children’s Hospital — as well as other healthcare providers in the area — have begun offering free electrocardiogram (EKG) screenings to all student athletes. Rossi recommends that all student athletes, once they’ve hit puberty, get screened once.
"We have a 100 percent follow-up on all of our children to make sure that they’re normal. If they have an abnormal EKG, and they do not have insurance, then we offer all of our services for free," Rossi said, adding that this included medical and surgical interventions. "We don’t want anybody to fall through the cracks with a potentially dangerous problem."
Miami Children’s Hospital has been offering the program since 2011. Since then, Rossi said they’ve screened about 3,000 kids. About half a dozen were found to have Wolff-Parkinson-White syndrome, a condition where an extra electrical connection exists between the upper and lower chambers of the heart. If left untreated, the extra connection can cause the heart to literally short-circuit, especially with the stress of exercise. With a catheterization procedure, it’s curable.
Christian Norniella-Burke, 16, a junior at Belen Jesuit Preparatory School, discovered that he had this syndrome after a screening at Miami Children’s. The hospital had screened the Belen crew team.
After a simple procedure and taking off two weeks from crew practices, Christian was able to continue the sport, something he plans to pursue in college.
Rossi is also currently treating two athletes with hypertrophic cardiomyopathy. Treating that can involve medication or surgery — and usually a decrease in the intensity of exercise.
According to Dr. Paolo Rusconi, medical director of Pediatric Heart Transplants and Cardiac Failure at the University of Miami Miller School of Medicine, there are some limits to what an EKG can find; while it’s very good at picking up electrical abnormalities, cardiomyopathy can slip through the cracks.
"[Cardiomyopathy] can be detected with an EKG … but unfortunately there are also cases in which the EKG could be normal. So the most accurate way to make this diagnosis is through an echocardiogram, an ultrasound of the heart," he said.
The problem? Echocardiograms are more expensive, more time consuming, and more complicated to administer and interpret — in short, said Rusconi, they aren’t suitable for mass screenings. And they won’t pick up the electrical heart abnormalities that an EKG will.
But Rusconi says that while it’s controversial whether the mass rollout of EKG screenings might be cost effective given some of its gaps, if the test is available for free, parents should absolutely sign up their kids. EKGs carry no risk, and those rare children who do have a problem are likely to not be alerted to it otherwise until it is too late.
In fact, UM offers free EKG screenings at Jackson Memorial, and also organizes screenings at Miami-Dade County parks. In partnership with Fit2Play, a Miami-Dade parks department after-school program, they’re also training coaches to recognize the signs of heart problems, as well as what to do if a child has a cardiac event.
While often symptomless, certain conditions that can cause SCA sometimes manifest themselves physically before cardiac arrest happens. Hypertrophic cardiomyopathy is one of them. Symptoms include shortness of breath, fatigue and irregular heartbeats that feel rapid. A genetic condition, cardiomyopathy should probably be screened for if an immediate relative has the disease.
Rusconi notes that these symptoms mirror a whole host of conditions — or just a general lack of fitness — but says that the hope of UM’s partnership with Fit2Play is to help coaches make educated guesses about who should be singled out for further medical attention.
"We do not expect a coach to diagnose cardiomyopathy or heart failure, but to recognize certain signs and alert the parent, [so] they can take the child to the doctor," he said.
In particular, he said, these symptoms manifesting themselves suddenly in a child who is usually very healthy and active could be a sign of trouble.
Virgil Julien, for example, lost his breath during basketball practice when he was 14.
"He was really exhausted and had to lay down on the floor to catch his breath," his mother, Hillary Julien, said.
His parents recalled commercials for free EKG screenings and local news reports of a football player who died from sudden cardiac arrest and suspected he may have a heart condition. They made an appointment to have him screened.
After the screening, Virgil was referred to a cardiologist who diagnosed him with hypertrophic cardiomyopathy.
Virgil, now 16, sees a cardiologist every six months and is back playing for Doral Preparatory Academy. The high school junior hasn’t had an incident since.
Miami Herald writers Stephanie Brito and Alexi Cardona contributed to this report.
Hospitals that offer free EKGs to students
Miami Children’s Hospital is offering free EKG screenings at its main campus as well as at any of its eight outpatient centers in Miami-Dade, Broward and Palm Beach counties. For more information or to schedule an appointment, call 855-624-3547.
Joe DiMaggio’s Children’s Hospital and the U18 Sports Medicine Program provides free EKGs year round, with results within 24 hours. Children must bring a copy of their completed sports physical. To schedule an appointment, call 954-265-0354.
Baptist Health offers free EKG screenings to Miami-Dade County high school athletes at its Brickell, Coral Gables, Miami Lakes, Palmetto Bay and Country Walk locations, from 9 a.m. to 4 p.m. weekedays. To schedule an appointment, call 786-573-6000.