Saturday, April 18, 2009

Could He have been saved?

Thomas Rayborn Hill III had no indication of how serious his condition was when he felt weak on March 10 during a basketball game at the REC IM at Eastern Michigan University.
According to those present at the REC IM that evening, Hill fell several times and reported feeling short of breath. Hill eventualy collapsed and was transported to St. Josephs hospital in Ypsilanti, MI where he was pronounced dead.

Could he have been saved?

The short, sad, answer is probably not. While autopsy results have not been released on Hall, sudden deaths are often caused by Hypertrophic obstructive cardiomyopathy (HOCM) . In many cases, first indication of the disease is sudden cardiac death.

While HOCM is seen in all age groups, the saddest cases are seen in young athletes. The American Heart Association reports that 36% of sudden deaths are due to hypertrophic cardiomyopathy. The AHA estimates that 50% of HOCM cases have no known cause. The other 50% seem to be inherited.

HOCM often has no warnings signs. If there are, they can mistaken for being tired, or worse yet, lazy. The primary warning signal is a heart arrhythmia- not seen, and often not felt by those afflicted.

Signs that should not be ignored: sudden weakness, shortness of breath, or dizziness. Most important for coaches,trainers and participants-any time an athlete faints, HOCM should be suspected and quick medical treatment initiated.

Once a patient has suffered cardiac arrest, there is a very small window of opportunity to provide life saving treatment. The only way to correct an arrhythmia is through defibrillation- an electric shock provided by a machine.

Once someone's heart has begun a fatal arrhythmia or heart attack, the window of survival is quite narrow. According the the American Heart Association brain death occurs within six to ten minutes. The availability of a Automatic External Defibrillation (AED) is essential.

AED’s are available to the public-but at a cost. An AED is often in excess of $1500. In the average gym, six or more are necessary for each area of the gym.

Of course, someone has to know how to use them. Classes are taught by Red Cross- and often part of a simple CPR class. Despite training being available, there needs to be someone present and willing to use the AED.

What could have been done?

“He needed to stop when he first felt something, and defiantly after he collapsed the first time, “ says Sara Wilchowsky, an exercise physiologist at Eastern Michigan University. “ “If he did not know enough stop himself, someone needed to get him to stop. It’s the only thing that could have saved him .”

There are ways to find out if you have HOCM. The AHA has come up with a 12 question list for screening student athletes. If any of the questions are answered “yes”, athlete should be further evaluated for cardiac issues.

Wilchowsky believes that every student athlete should have at the minimum an ECG-a electrical record of their heart beats, before beginning a sports program. This test can sometimes pick up subtle changes that indicate a heart issue.

“But, really, the best way to test for HOCM is with an echocardiogram,” says Wilchowsky.

Screening for student athletes

A echocardiogram is an ultrasound of the heart. Totally non-invasive and painless, it can pick up the thickening of the heart wall that indicates HOCM. The results are immediate. However, most insurances do not cover the test for sports physicals.

Like Wilcowsky, many sports physicians also believe this should be part of an initial screening for student athletes.

This past March, Chelsea Community Hospital offered cardiac screenings free of charge for student athletes. According to an article in the Ann Arbor News, these were provided as a service to the community.

These screenings provided an ECG as well as a simple cardiac echo. If any red flags appeared, they could return to their regular MD and undergo further screening.

In the A2 News article, Dr. Steven Yarows, chief of medicine at Chelsea Community Hospital said it was like “looking for a needle in a hay stack.”

Yarows, the father of two, felt it important enough to get his children echos before they began a sports program. 

The physician goes on to say in the Ann Arbor article “Why not do it for everyone else?"

According the the American Heart Association, 850 persons a day die from SCD. In a March 2007 study, about 1-20,000 deaths occur in student athletes of high school age a year..

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