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Behind the headlines: Sudden death in athletes

It’s an undeniable tragedy when a young athlete collapses and dies on the field, and it makes for alarming news reports. Often, the culprit is a condition known as hypertrophic cardiomyopathy (HCM). But should you be worried about it or concerned that it might strike your active son or daughter? Below are answers to some frequently asked questions about HCM.

Q. What is hypertrophic cardiomyopathy?

A. HCM is characterized by an enlarged muscle inside the heart, which sometimes obstructs blood flow. It may be genetic, but often the cause is unknown.

Q. How common is this condition?

A. HCM affects one or two people out of every thousand and is most commonly diagnosed in teenagers and young adults. (It typically occurs during a period of rapid growth, which is why it tends to appear in adolescence.)

Q. What are its symptoms?

A. People with HCM may suffer from shortness of breath while exercising, dizziness, blackouts and chest pain. Some experience cardiac arrhythmias—abnormal heart rhythms—that can cause sudden death. However, some people experience no symptoms at all.

Q. Does HCM always result in sudden death?

A. No. Only a small number of patients with HCM, about 1 percent to 5 percent each year, die suddenly, and certain risk factors are usually present. Risk factors include family members who have died suddenly from HCM, several instances of fainting in young people, a history of abnormal blood pressure while exercising and a history of arrhythmias along with other existing heart problems.

Q. Who should be tested for HCM?

A. Most doctors recommend regular screenings for any adolescent who has a relative with the disease, especially if the adolescent is an athlete whose heart muscle may be thicker than usual as a result of rigorous training.

Q. How is HCM diagnosed?

A. Most cases of HCM can be detected with an electrocardiogram, which records the electrical signals emitted from the heart. However, the current procedure of choice is an echocardiogram—basically, an ultrasound of the heart. Heart murmurs, abnormal “swishing” or “whistling” sounds made during the heartbeat, often go hand in hand with HCM. Experts estimate that 30 percent to 40 percent of HCM patients have heart murmurs.

Q. How is HCM treated?

A. Although no cure exists for HCM, certain drugs may help reduce the thickness of the enlarged muscle. Beta blockers and calcium channel blockers are commonly prescribed, as are antiarrhythmic drugs.

For severe cases of HCM or those that don’t respond to drug treatment, surgery is an option. Patients usually find that their symptoms disappear after surgery. Automatic implantable defibrillators can also help patients at greatest risk of sudden death. These devices contain pacemakers that emit electrical impulses telling the heart when to beat. If an arrhythmia occurs, the device “shocks” the heart into a normal rhythm.