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Heart screening may not have prevented Hamlin’s collapse

Tests such as EKG and echocardiogram can detect heart disease in young athletes, but they are not perfect.

CINCINNATI — Rapid on-site emergency care by well-trained medical personnel is widely credited for helping to save Damar Hamlin’s life. But the question of whether his cardiac arrest could have been prevented is far less clear.

Doctors say they are still evaluating what caused Hamlin’s heart to stop after a tackle during a Monday night game in Cincinnati. One possibility—accidental chest injury, called commotio cordis—is impossible to predict or prevent.

Pre-existing heart disease is the most common cause of sudden cardiac arrest in young athletes. Some of these can be detected with tests, including an ECG, which measures the electrical activity of the heart, and echocardiograms, ultrasounds that show how the heart muscle and valves work.

These tests cannot detect all heart conditions and sometimes miss those that can be fatal. They are commonplace in professional sports and are used in about half of NCAA programs, said Dr. Andrew Peterson, team doctor at the University of Iowa.

The American Heart Association and the American Academy of Pediatrics don’t recommend them for routine use in high school and youth sports, Peterson said, because false positive results would rule out too many athletes.

Routine physical exams should include questions about a family history of heart disease and warning symptoms, including episodes of fainting, heart palpitations and chest pain during activity, said Dr. Mariell Jessup, chief medical officer of the Heart Association. Heart tests will be needed to investigate these symptoms, she said.

“It is possible that someone will live to adulthood and not be diagnosed,” she said. “This especially happens in populations that are under-resourced or unable to see a doctor regularly. “

Hamlin’s health history has not been made public. Lifeguard Buffalo Bills, 24, remains in the hospital, but doctors say he is making noticeable progress, talking and breathing on his own.

Jessup said Hamlin was “extremely lucky to have people around who knew CPR” and that it was started right away.

He also benefited from the NFL’s regular emergency medical drills held in stadiums before every game.

“The meeting is an important checkpoint to ensure that officials, team medical personnel and matchday medical personnel are aware of all in-game procedures and resources related to player health and safety,” the online health and safety information reads. NFL players.

Sudden cardiac arrest is one of the things they try to prepare for. It is the leading medical cause of death in young athletes, although rare, with an estimated 1 sudden cardiac death per 50,000–80,000 young athletes each year.

A rare cause of such deaths is commotio cordis, which occurs when someone receives a sharp blow to the chest in a certain place during a certain period of the heart rate cycle. Injury causes the heart to tremble and stop pumping blood effectively. It used to be almost always fatal, but awareness has raised the survival rate to about 60%, said Dr. Mark Link of UT Southwestern Medical Center in Texas.

One of the most common heart conditions associated with cardiac arrest in athletes can often be detected on echocardiograms. Hypertrophic cardiomyopathy is a genetic disorder that can cause part of the heart muscle to thicken, making it difficult for the heart to pump blood. Affected people do not always have symptoms and often go undiagnosed.

Former Baylor basketball player King McClure had no idea he was sick until he had an ECG and echocardiogram at the start of his freshman year in 2015.

The diagnosis was devastating: the doctors said he could die if he continued to play. One doctor suggested an option – an implanted defibrillator that beats on the heart to restore a normal heartbeat.

The implanted device “by the grace of God never activated,” said McClure, now 26 and an ESPN analyst.

McClure said he saw Hamlin pass out and thought, “That could have been me. When you see things like this that hit so close to home, it’s a little scary,” he said. “I’m just grateful that Hamlin is okay and that he’s still here.”

Julie West of La Porte, Indiana, became an advocate for routine heart testing in schools, increased use of automated external defibrillators and routine cardio after her 17-year-old son Jake died of sudden cardiac arrest during a football practice. in 2013.

“For Jake, no one knew what to do right away,” she said. “The WUA was in the coach’s office. The coaches intervened and did CPR,” but it was too late.

Since then, awareness of AED has increased, and AED procedures have received a lot of attention at almost every level of the sport, even in high schools.

“This is part of our CPR refresh course,” said Eric McColiffe, varsity basketball coach at Indian Lake Long Lake in upstate New York. “We make sure to go through this and interview coaches about the whereabouts of the AEDs at each school.”

An autopsy revealed that Jake had a rare hereditary heart condition that did not cause symptoms and was not detected during routine medical examinations. His sister was later tested and found to have the same condition and now wears an implanted defibrillator.

West was a teacher when Jake died and says she was trained for active shooters and fires, but not for cardiac arrest.

“If they don’t have a cardiac response plan, they are not ready,” she said.

She formed a foundation that organizes ECG and echocardiogram screenings in Indiana schools.

West knows the tests aren’t perfect, but for her, saving one life is worth it.

AP sportswriters Tim Reynolds, Ron Blum and Ralph Russo contributed.

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