This is a transcript of a Dr. Jay Show broadcast on 1560TheGame in Houston, TX. Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon and a Fellowship Trained
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| Simplistic illustration of the cardiac stress test process. (Photo credit: Wikipedia) |
Sports Medicine Physician serving patients from Katy, Fort Bend County, Metro Houston and Southeast Texas from offices in Richmond and Sugar Land, TX. Dr Bennett is will begin to see patients at a new office in Houston on May 3, 2012. Call 281-633-8600 for an appointment.
Our special guest today is Dr. Terence Chang, a family practice physician Board Certified in Sports Medicine from Physicians at Sugar Creek in Sugar Land, TX. Bob Lewis, from 1560TheGame, is also participating.
Here’s the transcript of the fourth portion of the Show:
BENNETT: One thing that really scares me in regards to some of these cardiac issues is when you have a completely normal kid with no pre-existing cardiac abnormality, genetic issues, or any abnormal rhythm, and they get hit in the chest with a ball while playing baseball or something like that, or even hockey, and if they get hit in the chest in the right place, it can actually send their heart into abnormal ventricular rhythm which can cause immediate death as well. It’s something called comotio cortis, which is a very scary thing and Dr. Chang, are there any things out there in regards to preventing this, chest plates that kids are wearing, or do defibrillators help in those particular situations?
CHANG: They’ve done some research on certain types of chest plates and also on redesigning the ball, for example, the most common ones you’re going to hear about in these cases is during baseball and softball where the pitcher throws a fast pitch and it’s going to come at the batter or even the catcher and it hits them in the chest. And you’re right, basically what it is if you get hit in the chest at a certain timing of the electrical beat, it can send the heart rhythm into ventricular, what we call tachycardia, or ventricular fibrillation. What that does is the heart loses its coordination on how it delivers blood and so you lose cardiac output, so you lose the ability for your heart to profuse things like the brain and the kidneys and all that and the kid just basically falls down. For sports like baseball and softball, they’ve done a pretty good job with that. But, you know, with other things like martial arts, it still needs to be part of the game.
BENNETT: Dr. Chang’s going to go into some of the statistics regarding how often these kinds of things occur because I don’t want to go out there and scare everybody to where they think their kid has this cardiac issue but it’s also something to be aware of, and at the show here knowledge is power and you need to realize that. I want to go ahead and turn it over to you Dr. Chang and if you can address those two things for me that would be great.
CHANG: When we’re talking about the number of kids in the United States who play sports we’re talking about 25 million. And those are just kids and young adults. There’s an additional 500,000 who play on the college and professional levels. And when we talk about sudden cardiac death, we’re talking about a number somewhere around one out of every 200,000 in the United States and that number can range depending on who you are talking to. One out of 200,000 or one out of every 100,000. That number might sound like a lot, but if you compare it to other things that kill people in the United States, then that number is actually less than if you were to smoke or to ride a motorcycle without a helmet. And though cardiac is the main medical reason why kids who play sports die, the overall cause of why kids and young adults die is actually accidents and violence.
So we’re talking about something that’s very major, but to put it in context with everything I certainly don’t want to scare everyone out there. We had a young adult who was running a marathon, and, as you know we cover the Houston Marathon, working the start and finish line. This case is well known because she was actually on Channel 2 talking about it. She was an elite runner, in great shape, and about 20 or 30 yards before the finish line she drops. She doesn’t even catch herself; she just falls on her face. And so we rushed out and started transporting her to the medical tent. We notice, though, that she actually has no heart beats, no heart rate, and her face starts to turn blue. Once we get her back to the back, we put on the monitors and she, in fact, does have an abnormal heart rhythm and so she was shocked, she was shocked twice by a high level critical care doctor. And you know? After the second shock, we were worried that she might not come out of it. Luckily, she did. She had a tube, we put a breathing tube in her, and she was transported back to St. Luke’s. Turns out that in her case she had an abnormality in her coronary arteries, meaning that she was born with something that was abnormal in the way that her arteries feed the heart. That’s something that is very hard to detect from physical exam alone, even from EKG or an electrocardiogram. She was an elite runner and these problems, sometimes, don’t arise until they are in their final kick or running a marathon where they go into this anaerobic phase where they don’t require any oxygen but when you have an abnormality in your coronary arteries and you are in that setting, that situation where you don’t need any oxygen, your heart starts to take a hit.
BENNETT: Did she have any preexisting symptoms? Did she describe any of that when training for this marathon?
CHANG: No. And she actually went through surgery and had that repaired and is talking about coming back next year to do the half marathon.
LEWIS: Well is this one in 200,000 the number of those who actually die or is it one in 200,000 who have a medical issue?
CHANG: One in 200,000 die.
LEWIS: For me that seems like a significant number. There’s probably at least a half a million kids playing sports in Harris County, so that’s the potential for one or two a year to die from this. Is there going to be a difference if they check the heart after some type of exercise, when it’s under a little bit of stress, versus going into the doctor’s office beforehand?
CHANG: It depends on the situation. If the story is, “I feel great when I’m at rest, it only occurs five or 10 minutes into the exercise, I have some chest pain, I feel really
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| Meb Keflezighi wins 2009 Houston Half Marathon: www.chron.com/disp/story.mpl/sports/6217826.html (Photo credit: Wikipedia) |
dizzy and I have to stop,” then if we don’t pick up on a murmur in the office what we’ll do is we’ll check their rhythm and sometimes the EKG. But you’re right, it’s a resting EKG and you’re not challenging the heart and so even then you might not pick it up. If you do an echocardiogram it’s in a resting condition. And so looking at it structurally you may not be able to pick it up also. So the next step after all of that would be to do an exercise stress test. We actually put them on a treadmill and hook them up to some electrical leads and we watch the heart rhythm change as they exercise. And these are done usually by a pediatrician, a family medicine doc, a cardiologist – people that are experienced in doing exercise stress tests. It’s a possibility that you can actually go into an abnormal heart rhythm during the test so you want people who are experienced in getting you out of it. So that includes sometimes having the capability to shock them out of it or to deliver medicines that will get you out of that.
LEWIS: You wonder how these things get overlooked. Once or twice a year you hear about these college basketball players having these issues and they’ve been playing for 10 or 12 years and they’ve had all those physicals and somehow it’s missed.
CHANG: It just depends. Sometimes, for example, the most common reason why someone has heart issues is something called hypertrophic cardiomyopathy. It’s basically where certain parts of the heart get so large that they act by themselves, and that throws off an abnormal rhythm. Hank Gathers, as you know, from the 80s and 90s, a college basketball player out of Loyola, who had that issue, played basketball and he died. But other people, like this marathon runner, have a coronary artery issue and it’s a different type of issue. Others, you know, will have some electrical problems like what’s called Long QT syndrome or brugada syndrome and those look differently while others will have a genetic defect like Marfans syndrome so it really depends on what the underlying cause is. I will say, though, that most of the times for coronary artery disease, it’s a diagnosis you make post-mortem. Meaning like a lot of people find out after the fact what the reason was.
If you’d like to make an appointment with Dr. Bennett, please call our office at 281-633-8600.
