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Joining us is Dr. James Weber, Emergency Department Physician & Chief Research Officer at Hurley Medical Center. Dr. Weber will be discussing hypertrophic cardiomyopathy, a serious condition that can cause sudden cardiac death in young athletes.
This Think Healthy, Think Hurley interview is brought to you by Hurley Medical Center, the region's premier public teaching hospital in Flint, Michigan. This Blog Talk Radio is another way Hurley is educating the greater Genesee County Community and beyond about health and wellness. I am your host, Ilene Cantor, and today's topic is hypertrophic cardiomyopathy, a serious condition that can cause sudden cardiac death in young athletes. Joining us now is Dr. James Weber, ER Physician at Hurley Medical Center. Thank you for joining us.
Tell us doctor, how important is cardiac screening for these teenage athletes?
Well Ilene, the knee jerk answer to that question is of course very important, but ironically, the true answer to that question is it is more nebulous than one would think and is highly debated amongst members of the scientific community. So to be fair and balance, I'll briefly give you both sides of the argument, and this is an interesting and timely debate because the overwhelming amount of media attention is rich in deficits generated is forcing the medical community to take a closer and more scientific look at this problem literally as we speak. So, proponents in favor of screening believe that it is indeed very important for a number of reasons. First of all, nearly 100 young athletes die suddenly and unexpectedly in the U.S. each year. And while any death that occurs prematurely in a child is tragic, these are typically individuals who are healthy, without underlying medical conditions or chronic illness, who died unexpectedly and many times without warning. The second point that is well stated and well defined is really the topic of discussion. Most of these deaths are attributed to underlying structural heart disease, the most common being hypertrophic cardiomyopathy. Now conversely, what is understated by the medical community is that the majority of athletic deaths due to hypertrophic cardiomyopathy in both high school and say, for example, collegiate athletes occur in African-Americans, and African-American individuals have historically been significantly underrepresented in screening programs that have been conducted elsewhere and previously. I think the third point that I would bring up is that this type of screen -- and this important for parents to realize, is not part of the routine history and physical examination that a child would receive, for example, at a pediatrician's office or during a routine sports physical. This type of screening is expensive, ranging from approximately $1,000 to $2,000 per individual, and it is not covered by any insurance carrier that I'm aware of.
So that access to this type of program has previously been limited to some degree by socioeconomic status unless a certain child's athletic ability rose to the level of a world class or Olympic athlete where participation and such screening program is more likely to be offered or in some cases mandated. So therefore, while most opponents argue yet high impact but it's an exceedingly rare problem, as a researcher, it's my opinion that the true prevalence of this problem is really largely unknown because of the selection by us amongst previously studied cohorts. So in other words, one could make the argument. And I feel strongly about this, that the most likely individuals to screen positive for a cardiac abnormality are historically the least likely to have undergone screening. And I think the final argument which is quite relevant to our particular circumstance is that, what effect does premature hypertension contribute to hypertrophic cardiomyopathy. We know, Ilene, that hypertension is a pervasive problem amongst our adult population here. And thus screening high school kids may ultimately lead to early detection and subsequent disease prevention, so we're also gonna be screening for that. In brief, really be opposing arguments are centered principally around two variables. The first is cost and the second is the burden of what to do with the false positive test because the argument is that the screening provokes a downstream subsequent testing that in the long run may end up being a false positive test. And then the cost is a bona fide argument. The best data in the world come from Italy for the last 30 years. Preparticipation screening there has been mandated by their Ministry of Health and they have long term longitudinal data that demonstrates a 90% absolute risk reduction and cardiac death in young athletes. Now despite that, that would still not make this a cost-effective strategy in the United States for the mere fact that we have at least ten times the number of young athletes as they do in Italy and that would come out at an estimated cost of about US$2 billion.
So our ultimate goal with this program, Ilene, is to take the cost to screen individuals off the table. It should come as no surprise to you that my colleague, Scott __04:57__ and I had very little difficulty in recruiting volunteers to help with this program. Most -- all of us who have children were keenly aware of the devastation that premature son cardiac death can live in it's wake and if we are successful with this launch, our intent is to aggressively pursue philanthropy dollars to develop that infrastructure necessary to carry the screening process out free of charge in the future and on a recurring basis. And the other opposing argument really is the false positive. So say for example we identify a potential problem to screening and that necessitates a consultation with a pediatric cardiologist and potentially the need for further testing and let's say ultimately the child is determined to be just fine and ultimately cleared to compete. Well of course, there's the inconvenience of spending a half a day in a doctor's office that was ultimately determined to be unnecessary and the potential of added cost. I think the true determination of those cost really must be balanced against the financial and quality adjusted life. A loss if a child's life was lost which potentially could have been screened -- saved by the screening process for example. I think the final statement there is that it's noteworthy that there is a trickle-down effect, as all professional athletes that I'm responsible for as a State Commissioner go through this process. The NCAA looks like they're soon to follow and I think the trickle-down effect is that quite possibly in the future if we can better tweak the indices most predictive from the screening tools of which individuals stand the most benefit from such screening versus those who don't. I think that you'll see why __06.37__ screening, but until that day, we believe it's best to screen all such student athletes.
Doctor, what are the signs and symptoms of hypertrophic cardiomyopathy?
Well, sudden death and the danger, Ilene, is the sudden death and hypertrophic cardiomyopathy can occur without warning signs. And often times, when that is the case, it's caused by lethal rhythm disturbance oftentimes what we call ventricular tachycardia or ventricular fibrillation. The common signs and symptoms, an individual has fluttering or pounding of the heart, palpations, otherwise known as skipped beats, unexplained dizziness or fainting, and exertional chest pain or discomfort. These are all signs and symptoms that the individual should report not only to their parent but to their primary care physician.
What could the screening involve, doctor, an EKG and what other type of components of this type of examination would be included for the parents out there listening?
Certainly, yeah. What will happen, it's gonna be a very methodical process. The child will present and they will undergo a 12 element participation screening tool that has been validated and recommended by the American Heart Association. This would involve elements of the personal history such as previous chest pain, unexplained passing out, unexplained fatigue, prior recognition for example of a heart murmur, and the presence, as I previously mentioned, of elevated blood pressure. There's family history factors into this as well. Was there premature death in the family? Is there disability from heart disease in a closer relative who was under the age of 50? And then specific knowledge of certain other less common but yet high impact conditions as well amongst family members such as channelopathies, Marfan syndrome, long QT syndrome. And then they will undergo physical examination which is specific to the heart. We will be checking for heart murmurs. We will be checking femoral pulses to exclude what we call coarctation, as well as other things. Once we put them through that, all individuals will then receive an EKG. Our specific validated findings that when we will have three cardiologists onsite who will be looking to identify specific guidelines, again which are highlighted and recommended by the American Heart Association and American College of Cardiology, to help identify specific findings that may raise a red flag for one of these conditions. And if in fact based upon the data screening tool and the EKG a red flag is signaled, then an echocardiogram would be performed. Now statistically from the Beaumont experience Ilene, that's about 15% of all such patients.
So 85% of the screening we would be able to successfully and confidently stop with the screening tool, the physical exam and the EKG and if indeed an echocardiogram is necessary. Then we would have the ability to do that on site. Upon check out, we will be sitting down and discussing with the individual as well as their parents and providing them a report of our findings and what subsequent recommendations should or are necessarily to be made with regards their ability to compete in sports, what type of followup patient have on ongoing basis.
Well I know that you did make reference to Beaumont Hospital in Detroit nationality started this cardiac teen athletes screening program. To date, 7,000 teens have been screened. What is the bottom line some final comments for parents about the importance of their teen athlete getting checked, doctor?
Well, there's a lot of things. That's a long winded answer. I think parents, a couple of things parents should know. They should talk preemptively with their children. Oftentimes, kids don't talk to parents about symptoms. They ought to be talking with their parents or coaches about, hey, I've had chest pain or my heart's been fluttering or I've been dizzy or passing out, or I'm just tired and weak for no apparent reason. That's very, very important. The other important piece is, you know we just a case a couple of days ago where there was a potential sudden cardiac death that was curtailed because wisely, an AED was on site, it was appropriately used. The child was defibrillated and actually the last I heard the child was doing quite well. And so AEDs are very important educational tool for not only our kids to know about but the parents to know about and we will also be doing an AED demonstration and education for the parents who present and bring their kids to our program.
We appreciate your information today, Dr. James Weber, ER Physician at Hurley Medical Center. This Think Healthy, Think Hurley interview is brought to you by Hurley Medical Center. If you would like to find a Hurley physician, call 1888-611-HMC.
It's good to talk.