Why young folks die from cardiac arrest

Here's an article written by Mehmet Oz and Mike Roizen. It's well-written, it mentions the most important points, but stops short of getting to the tragedy of it all, and it doesn't provide a solution.

They focus on HCM, a congenital disorder that yields a thicker left ventricle wall. In times of high demand on the heart (high exercise combined with high emotion (ever read about the basketball player that made the game-winning shot just before the buzzer and then died?) the heart can't supply the blood flow needed, and the person dies. Not to be macabre, but you can see this happen at SLICC's web site: Miki, who was 24 at the time of his death, was in the middle of a professional soccer / football match when his heart stopped. He put his head down - assumedly because he felt light-headed - and then collapsed. He didn't make it - which won't surprise you if you look closely at the quality of the CPR he got in the video.

But that's not the only reason young people die during sports. There are congenital problems with the heart's electrical circuitry such as WPW and long QT syndromes. Furthermore, there are fatal conditions (such as Comotio Cordis) that can be triggered by a sudden blow to the chest during a short but critical part of the heart's natural rhythm. This is most often seen when a lacrosse player is struck on the chest with a high-speed lacrosse ball.

So why don't we screen people for these conditions? Good idea, and in fact, Holly Morrell spends her time raising money to pay for screening for numerous conditions that might cause sudden cardiac arrest, but here is no underlying defect that permits Comotio Cordis to happen, because Comotio Cordis doesn't happen because of an underlying defect.

Here is the tragedy:
- To spot HCM - the hypertrophic cardiomyopathy referred to in the article below, you need to perform an echo cardiogram, and a cardiologist has to read it. Even then, it's not a really clear-cut test in some cases, and it's expensive.
- You can spot most electrical defects with an EKG, and a cardiologist will have to review that, too.
- You can have genetic screening performed for only $2,400 per person, but it's sensitivity is only 50% or so. That means it only picks up half the people you are looking for.
- You can reduce the cost of the screening by beginning with a smaller population, for example all 7th through 12th graders, and you can begin by administering a questionnaire designed to uncover family history that might predispose a child to an elevated risk of having one of these conditions. Any child that comes from a family with a suggestive history would then be screened by one of the more expensive methods.

Making some assumptions about the cost and efficacy of the various approaches, a rough estimate is that we could prevent about half the deaths from these causes. with a program that screened all athletes from 7th through 12th grade the first year and all 7th grade students thereafter. In Chatham County, Georgia, that would cost $30,000,000 the first year and $5,000,000 every year thereafter. Or perhaps the existing 7th through 12th population could be brought into the program over a period of six years. That would cost $10,000,000 every year for the first six years and $5,000,000 every year thereafter. To approximate the cost throughout the U.S.A. multiply those numbers by 1,000. It doesn't matter whether these cost estimates are high by a factor of ten - and I don't believe they are: this funding is not available.

There is a way, however, to prevent two-thirds of not only these defect-related and two-thirds of all the Comotio Cordis deaths: have everybody who plays or coaches or referees sports where these deaths might happen be trained in Bystander CPR and to have an AED at every practice and game. The cost can be negligible. Bystander CPR can be taught in a regular class session, and a suitable course is available at a minimal charge.

Now, here's the article that triggered my rant.