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Should teen athletes be tested for sudden cardiac arrest?

Del Oro runner Lucas Armand remains hospitalized
By: Sara Seyydin Journal Staff Writer
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Lucas Armand was mini-golfing at Scandia on Sept. 23 when he went into sudden cardiac arrest. Medical professionals were able to revive the 14-year-old Del Oro cross country runner within 30-45 minutes, but he had to be placed in a medically-induced coma. Despite familial testing and an evaluation of Lucas’ medical history the cause of his case of sudden cardiac arrest is still unknown, according to his father David Armand. Although Lucas survived, the American Heart Association estimates 1 out of every 30,000 to 50,000 U.S. high school athletes dies each year from sudden cardiac arrest. While Armand is still searching for answers in Lucas’ case, he said he would be in support of creating local sudden cardiac arrest screening programs for student athletes. Armand said if these programs could identify students at risk of a sudden cardiac arrest, other families may be saved from experiencing a similar tragedy. Organizers of sudden cardiac arrest screenings in other areas say the programs have found irregularities that could have been deadly to young athletes. But some local doctors say they are concerned the screenings may give people a false sense of security. Sudden Cardiac Arrest hits close to home Since his sudden cardiac arrest, Lucas has spent many days in the intensive care unit, even once falling to 95 pounds. Currently, he has been moved to UC Davis Medical Center from Kaiser Permanente Roseville Hospital, out of the coma, but fighting for the function he once had. “Of all the kids in the world, what are the chances this would happen in the Loomis Basin?” Armand said. “It just breaks my heart what happened to my boy. Humans don’t do, ‘I don’t know’ very well and I have a feeling that may be what the result is.” When the heart suddenly stops beating due to an irregular heart rhythm sudden cardiac arrest occurs, according to the American Heart Association. Without treatment death occurs in minutes. While several cardiac conditions can contribute to a case of sudden cardiac arrest, the most common is an enlarged heart, or hypertrophic cardiomyopathy. Bev Heller, of Scappoose, Ore., started a screening program for student athletes in Portland when her 17-year-old son, David, passed away suddenly due to the condition in 2005. Heller said David died in his sleep the night after a basketball game. According to Heller, the annual screening includes a patient family history, height, weight, blood pressure, body mass index, EKG and a cardiac exam. To reduce costs, the screening is done by an all volunteer staff of cardiologists, pediatricians, nurse practitioners, EKG technicians and lay volunteers. Armand said anything that could have prevented this from happening to his completely healthy son, or other people’s children, would be worth it. “The pre-screen would probably help,” Armand said. “I’d have him go through it a hundred times if it would mean he wouldn’t have had to go through this.” Last year, 253 athletes were screened through Heller’s Teen Athletic Cardiac Screening Program. Out of them, 47 were not cleared. In that case, Heller said the athletes are directed to see their doctor for more in-depth testing, such as an echocardiogram. If more serious irregularities are confirmed, Heller said sometimes students are instructed not to play sports. Heller said teens are at particular risk for a sudden cardiac arrest because their bodies are growing. Families pay just $10 per child. “We find that if there is a fee, people are more committed to coming,” Heller said. Del Oro High athletic director Justin Cutts said he would be in favor of any program that could possibly save a life, depending on its specifics. Del Oro implemented a baseline concussion testing program this year and all athletes are required to have physicals, but Cutts said sudden cardiac arrest is a new concern because of what happened to Lucas. “It hasn’t even been addressed at any athletic director conferences I have been to. Most of our information we get from the section. That is kind of where you hear about the new issues, and the magazines,” Cutts said. “And obviously things like this where you have a kid and everybody is shocked because he was a pretty exceptional athlete. Unfortunately, sometimes that is what makes us aware.” A doctor weighs in While the programs have helped some students, Dr. Diane Sobkowicz, an Auburn cardiologist and former President of a local American Heart Association, said they may not be the best solution. Sobkowicz said the screenings aren’t able to pick up all of the causes of sudden cardiac arrest, so they may give families a false sense of security if their athlete is cleared. For example, some sudden cardiac arrest cases are caused by a blockage to the arteries that supply the heart muscles with blood. That can only be indentified with treadmill tests, according to Sobkowicz. “The screening program — this is something that happens rarely, so that has been a matter of debate,” Sobkowicz said. “If you do the EKG, that will pick up a few more percentage points but that doesn’t really give you the decisive information. The main test you use to diagnose is an echocardiogram. If you do an EKG, that doesn’t make a difference to picking some of these kids up or not. They may feel a false sense of security.” She said increasing awareness of possible symptoms of sudden cardiac arrest and family history may better prepare parents to know if their child is at risk. She said many times parents dismiss symptoms like heart palpitations and shortness of breath because they don’t realize how serious the condition could be. The cost of the program is also very high when compared to the number of kids who have a sudden cardiac arrest, according to Sobkowicz. Sobkowicz said the consensus on the effectiveness screening varies. Cardiac screening was mandated for athletes from 12-35 in Italy in 1982. One study said the rate of death from sudden cardiac arrest was decreased from 4.19 percent in the pre-screening period (1979-1981) to .43 during the latest period studied (2001-2004). Conversely, a study conducted in Israel showed mandatory screening beginning in 1997 had no impact on the amount of deaths from sudden cardiac arrest. “If you spend the $2 billion on pre-sports EKGs that saves 100 lives, which they say works out to about $20 million a life. For a kid, for anybody, it would be worth it,” Sobkowicz said. “My main concern is not necessarily the money, but the false sense of security people have from not going beyond the EKG.” Reach Sara Seyydin at saras@goldcountrymedia.com. ______________________________________________________ Is your child at risk? The American Medical Association published a study on Nov. 13 that said many doctors and athletic directors aren’t following proper screening guidelines to assess sudden cardiac death risk for student athletes. The survey conducted of 1,113 pediatricians and 317 high school athletic directors in Washington state revealed the following: Less than 6 percent of doctors fully follow national guidelines for assessing sudden cardiac death risk during high school sports physicals. Less than half of the doctors and only 6 percent of the athletic directors reported that they were even aware of the guidelines. 28 percent of doctors didn’t always ask about chest pain during exercise. 22 percent of doctors didn’t always ask about unexplained fainting. 26 percent of doctors didn’t always ask about a family history of early death. 67 percent of doctors didn’t always ask about a family history of heart disease. ______________________________________________________CPR saves lives Dr. Diane Sobkowicz of Auburn Cardiology Associates said it is important for everyone to learn Cardiopulmonary Resuscitation (CPR), since it can save victims of sudden cardiac arrest the more quickly it’s performed. She even recommended watching instructional videos on CPR on YouTube if taking a class wasn’t immediately possible. “CPR immediately — not even blinking. The faster you get some oxygen to the brain the better,” Sobkowicz said. “Young kids are really resilient unless they don’t have any blood flow.”