Youth sports define life on the Westside. There are high school sports teams in Westwood and Santa Monica. There are sports clubs like soccer and volleyball in Brentwood and Pacific Palisades. Los Angeles teenagers engage in sports and activities like basketball, water polo, track, and other year-round traveling sports teams. The majority of them are healthy. A few, however, may have heart conditions. Dr. Maria Tehrani, cardiac surgeon at the Ronald Reagan UCLA Medical Center in Westwood, has seen athletes in her practice with structural heart issues. Most of the time, there are signs, but they go unrecognized and get explained away.

Why Healthy Athletes Are At Risk

Sudden cardiac arrest in young athletes is rare. In most cases, there is an underlying condition that either was present at birth, or developed over the years.

Hypertrophic cardiomyopathy is one of the most common causes. So is anomalous coronary artery due to the presence of a vessel that crosses in a different path and gets compressed during hard activity. Long QT syndrome and catecholaminergic polymorphic ventricular tachycardia, for example, are electrical problems that can cause dangerous heart rhythms during physical activity. Arrhythmogenic right ventricular cardiomyopathy is a progressive condition that causes heart muscle to be replaced with fat and fibrous tissue. Marfan’s syndrome is a connective tissue disorder that can weaken the aorta.

There is another myocardial disruption, commotio cordis, caused by a sharp blunt blow to the chest that occurs at a specific point in the cardiac cycle. This disruption does not involve any underlying disease, and is recognized as a problem in all of baseball, hockey, and lacrosse.

Each of these conditions presents without warning. Intense exertion is the trigger, and as a result athletes are the most affected.

Symptoms Most Regularly Ignored

The number one symptom is fainting due to intense activity. This is most often associated with heat, dehydration, and/or not eating. Fainting post activity is generally not a concern. Fainting during intense activity should be evaluated to return to sports participation.

Chest pain or discomfort should be dealt with and investigated just as if a person complained of difficulty breathing (especially if this happens to an athlete who is in good shape and you see this athlete’s inability to keep up with the rest of the team). There are many other symptoms that should be reported (i.e., unexplainable drops in performance, palpitations).

The most concerning symptom that four out of every five athletes do not report is fainting post activity. This can be due to a number of issues and should be reported.

This is a worrisome symptom, but if Carolina athletics’ culture continues, fainting post activity will be normalized. Within this context, playing through pain and discomfort is appropriate.

What a Standard Sports Physical Catchs and Misses

Most sports physicals for Los Angeles schools and leagues begin with a personal and family history questionnaire and end with a physical examination that involves listening to the heart and taking the patient’s blood pressure. When done thoroughly, these sports physicals reveal significant information about the athlete that will help the parents make a more informed decision about their child participating in sports.

What these sports physicals lack is often a finding made plain through an ECG of the heart. ECG’s are much more useful to determine if an athlete has any cardiac issue. In fact, many other countries who have adopted sports physicals recommend cardiac testing on all competitive athletes through ECGs. The United States has not adopted a cardiac testing policy based on the cost of the testing, the number of ‘false positive’ results, and the resulting unnecessary tests and temporary ban from competitive sports.

The use of ECGs for athletic populations, especially young person competitive sports, is a growing practice among sports medicine clinicians. It is equally as important in competitive sports here in LA. Families should opt for a cardiac assessment for this reason. Parents should also be aware that the signed consent acknowledges commitment to answer completely and thoughtfully on the questionnaire.

Many Parents Are Surprised to Find Out…

Many competitive sports related sudden deaths are caused by conditions that are heritable. In fact, parents are encouraged to tell their family’s story about a sudden death that occurred before the age of 50 to include any sudden unexplained death, drowning, or weird accidents. These may hide inadvertently an underlying heart condition.

When completing sports physicals for my family members, I check the boxes for hypertrophic cardiomyopathy, long QT syndrome, Marfan syndrome, implantable defibrillators, pacemakers, and heart surgery (done at a young age). When a family member’s heart condition is documented, other family members in the first degree (sibling, parent, child) should be screened as well.

Emergency Preparedness At The Field

Survival of sudden cardiac arrest is highly dependent upon the time it takes for a defibrillator to reach the victim. There is a high likelihood that waiting for paramedics will not be fast enough, especially on a large campus or a remote field. California requires schools that participate in interscholastic sports to have AEDs available. Most private training facilities and clubs voluntarily have AEDs on their premises. Although it is good to know that AEDs are available, it is better to know the location of the AED and how accessible it is during practices and visitation weekends, as many coaching staff are not trained in CPR and AED use. It is beneficial to know if the sports programs have a written emergency action plan.

Where to Seek Cardiac Specialist

A young athlete must get a cardiac evaluation and return to play clearance before they can return to play, if they have passed out because of activity, if they report chest pain during exercise, if they have seizures during exercise, or if they experience palpitations and/or shortness of breath that is not explained by their normal activity/fitness level.

Screening is required for those without symptoms who have a family history of sudden unexplained death before age 50, a diagnosed inherited heart condition in relative, personal history of heart murmur, congenital heart disease, or Kawasaki disease. Athletes known or suspected to have Marfan syndrome based on an even taller than usual, with long arms, and joint hypermobility, should also be assessed for aortic involvement.

Dr. Tehrani evaluates children in greater Los Angeles for structural and congenital cardiac diseases. Based on the evaluation, he develops safety guidelines for the family. Most of these evaluations are reassuring. The athletes return to competition and feel safe about participating, instead of wondering about the possible outcomes.

Maria Tehrani, MD Cardiac Surgeon | Ronald Reagan UCLA Medical Center

Phone: 818-350-9899
Email: welcome@mariatehranimd.com
Address: 757 Westwood Plaza, Los Angeles, CA 90095
Hours: Monday–Friday, 9AM–5PM
Serving patients throughout Westwood, Brentwood, Beverly Hills, Santa Monica, Century City, Bel Air, Pacific Palisades, Marina del Rey, and Culver City.