Sudden death in young athletes

Hypertrophic cardiomyopathy

Ask The Expert

June 05, 2008|By Holly Selby

Hypertrophic cardiomyopathy (HCM), is considered the No. 1 cause of sudden death in young athletes. But this inherited condition, which causes the thickening of the heart muscle, frequently has no symptoms, says Dr. Theodore Abraham, associate professor of medicine in the Division of Cardiology at the Johns Hopkins School of Medicine and director of Johns Hopkins' Hypertrophic Cardiomyopathy Clinic.

What is hypertrophic cardiomyopathy?

It is an inherited condition most commonly associated with the thickening of the ventricular muscle or the heart wall muscle and ends up being the most common cause of sudden death in those below 30 years of age. It effects all ages and genders and does not appear to have an ethnic preference.

How prevalent is HCM?

It is thought to occur in one in 500 or one in 700 members of the general population. So it's not that rare.

Why don't we hear more about it?

It is a complex condition, and I think there isn't enough awareness in the general community. ... It seems like it gets the most media play when a famous athlete or high school or college athlete collapses and even dies from this condition. That is when people become aware of it.

It is commonly mistaken for the thickening of the heart that occurs with high blood pressure. Or sometimes when it isn't recognized at an early enough stage, it is classified as heart failure.

If you are diagnosed with Hypertrophic Cardiomyopathy, what is the prognosis?

It can lead to heart failure. The positives are that it may not affect longevity. In most cases, there are specific measures that one can take to preserve both longevity and lifestyle. It is thought that it won't shorten a life span if the appropriate therapies are applied in a timely fashion.

What are the symptoms?

Chest pain, shortness of breath or passing-out spells. But very often it is completely asymptomatic. On the medical side, the most common presentation might be a heart murmur. If we are talking about an athlete who has this, the person might have chest pain, or they can't keep up with their peers, or they have fainting spells.

How is HCM diagnosed?

The best way to diagnose this is with an echo cardiogram or an ultrasound of the heart. This will pick up the thickening of the heart muscle or any other conditions that are typical.

What is the treatment for HCM?

The treatment may be simple or complex, depending upon what the heart looks like at the time of evaluation. It can vary from just therapy to a minimally invasive procedure to open heart surgery. A very, very small percentage of patients might need a heart transplant.

What do you tell patients who are diagnosed with this condition?

That this is a genetic disease; that they will need medical therapy; that they will need close follow-up; and that they will need to tell their family members to be screened, because it does run in families. Then we discuss whether they need surgery or other treatment.

What other steps might the patient take?

The standard of care is that we cease all competitive athletics because the stress of competitive athletics may be too great. The recommendation is that you can continue some physical activity, but no competitive training. We ask the patient to pursue mild or moderate activities, and what that is changes from person to person.

When is this disease typically diagnosed?

It is highly variable because there may be no symptoms. That is why [last month] we held the Johns Hopkins Heart Hype Program, a screening at Morgan State University where the state high-school track and field meet was held. We screened about 250 athletes for this particular condition to raise awareness among young athletes about the importance and significance of heart disease. We had about 50 volunteers from the medical and paramedical communities there to screen, and we hope to repeat the event every year.

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