Screen all student athletes

By Garth A. Rattray

Tragically, a few months ago, grade nine student, Abigail Hyman, fainted and died while at Marymount High, her school, in St Mary. It was speculated that she died from a heart attack.

A popular Observer columnist used the incident as a springboard to launch a broadside against the medical profession in his article, 'How much do you trust your doctor?' He (mysteriously or perhaps mischievously) aligned and linked the unfortunate death of young Abigail with the Medical Council of Jamaica's warning/reminder that doctors are to get their required number of Continuing Medical Education (CME) hours in order to be registered annually. He went on to pose a series of made-up scenarios and questions that ended with the veiled suggestion that Abigail's demise could have been prevented if doctors did their job properly.

Obviously, he does not know that the most common cause of sudden death from cardiac causes in children and adolescents is sudden (unexpected, unpredicted) fatal cardiac arrhythmias.

I won't bother going into the several other errors within the article; suffice it to say that by ascribing so many negative things solely to physician incompetence without any knowledge of the financial constraints and inner workings of the 'system' is unfair and incites hostility toward doctors.

Following hot on the heels of that terrible incident was the sudden death of 18-year-old St Jago student, Cavahn McKenzie. He collapsed and died in Tobago shortly after competing in the junior men's six-kilometre event at the North American, Central American and Caribbean Athletic Association Cross Country Championship. Initially, his death was blamed on a heart attack, but then the autopsy came back as "inconclusive".

common cause of death

The fact of the matter is this: sudden death in young athletes is very rare, but when it occurs, it is shocking, high-profile and devastating. By far the commonest cause of sudden death in young athletes is a fatal cardiac arrhythmia - ventricular tachycardia (a very rapid beating of the more powerful chambers in the heart) leading to ventricular fibrillation (a disorganised, rapid twitching of those same muscles). At this point, the heart fails to beat purposefully and it often leads to death.

In the wake of this disaster, Dr Warren Blake, president of the Jamaica Athletics Administrative Association, made public the hope that there will be an islandwide screening process for all athletes selected for national representation. He cited several logistical hurdles in achieving this goal. So there arises the practical question of how to screen all those athletes.

In brief, a cardiology colleague pointed out that more than 30 years ago, Italy enshrined in law compulsory pre-participation screening in competitive athletes. Through the taking of a thorough medical history, performing a physical examination and a 12-lead electrocardiogram, they screened for hypertrophic cardiomyopathy (HCM, the disease caused by abnormally thickened heart muscle, which is thought to precipitate fatal arrhythmias). Because of this compulsory screening, Italy has a much lower incidence of sudden deaths in young athletes linked to HCM.

For completeness, it must be mentioned that HCM is not the only cause of heart-related sudden death in young athletes. However, screening in general can reveal several other potential killers and has been proven to save lives.

Consultant cardiologist Dr Lisa Hurlock-Clarke pointed me to a study showing that this screening method is efficient and cost- effective. She also shared a presentation she did showing that, in 2009, the University Hospital of the West Indies Cardiology Unit screened members of the Jamaica swim team. Incidentally, all were passed fit.

Given our growing interest in track and field, our undisputed world dominance, the drive to eclipse our current track heroes, more and more young people are competing seriously and becoming elite athletes. We owe it to them to formalise a compulsory national screening programme ASAP.

Garth A. Rattray is a medical doctor with a family practice. Email feedback to columns@gleanerjm and garthrattray@gmail.com.