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Peter Greene was an active, sporty teenager. So when he died suddenly at the age of 15, his family’s shock and grief were especially intense.

“We lost our son 10 years ago to sudden cardiac death,” explains Peter’s father, Michael.

“There was no history, no warnings, he was a normal healthy young man, sports-orientated, full of the joys of life, and he died without any warning.”

Driven by their son’s memory, Greene set up an awareness and support group, and are now involved in a new initiative in Tallaght Hospital to target cardiovascular disease in young people.

The dedicated unit, due to open in January, will offer potentially life-saving screening for families affected by sudden cardiac death (SCD) and other heart complications in young people.

In SCD, patients die within an hour from the onset of symptoms, explains consultant cardiologist Prof Ian Graham who, along with Dr David Mulcahy, is spearheading the new Tallaght unit in the Institute of Cardiovascular Science.

He estimates that around 5,000 people in the Republic die from SCD each year, and about 60 of those are under 35 years of age.

“In a youg person it’s terribly tragic, it has terrible, devastating spin-ff effects,” he says.

In people over 35, the main cause of SCD is coronary heart disease, or hardening of the arteries, says Graham. In younger people, SCD is often due to abnormalities in the heart muscle or valves, or disturbances in the electrical signals that regulate the heartbeat.

This may stem from infection, congenital heart disease or genetics, depending on the condition, he adds.

High-profile SCD cases in seemingly healthy athletes such as Tyrone Gaelic footballer Cormac McAnallen have raised awareness of the problem, and a recent Task Force report recommended that first-degree relatives of people affected by SCD should be screened.

The new unit at Tallaght aims to target the highest-risk groups.

“There are certain clear warnings. If there’s any history in the family, they do need to be screened,” says Graham, who notes that symptoms on exertion like getting light-headed or fainting or chest pain also need to be taken seriously.

He adds that people can access the unit through their GP or through a support organisation such as Cry. Cardiac screening is also available at Dublin’s Mater Misericordiae Hospital.

“Everything is welcome and it’s a matter of us all linking our resources,” says Graham.

The screening process at Tallaght will involve taking a detailed medical history and investigations such as blood tests and monitoring the heart rate during exercise.

“It’s quick and routine. We would try to provide this at a single visit and we would hope that it will be available without charge to anyone,” says Graham.

“Those found to be at risk can then be treated through lifestyle change, medication or surgery, depending on the diagnosis, he adds.

Scientists are also beginning to unravel the inherited factors that contribute to SCD in families and the Tallaght unit will benefit from links into research and expertise at Trinity College Dublin and at other teaching hospitals, particularly in the area of genetics.

“You simply cannot counsel these families adequately without expert genetics,” says Graham.

At the unit, cardiologist Dr Deirdre Ward will work with families affected by SCD. She is returning from the Heart Hospital in London, where she researched inherited cardiac disorders.

“The important thing is that even though some of these conditions can be fatal in some family members, not everybody in the family who inherits the genetic factors will suffer the same outcome. There are ways of identifying people who are at higher risk,” she says.

And while the unit will concentrate on screening younger people, there will be no defined cut-off age, according to Ward.

“We’re not going to be exclusive and say you are too old to be seen even though you have a rare inherited condition. It will be about trying to focus on young people and being preventative but also managing older relatives, as necessary.”

The new unit will be funded for three years through the Department of Health as well as private and philanthropic donations.

“We will keep a close eye on outcome measures and see if we can make a difference, and if we can then be looking for more public funding,” says Ward.

Greene has been involved in fundraising for the unit and is delighted to be involved in such a positive step, says Greene.

“SCD is a dreadful tragedy, it’s indescribable. The screening is very important to help clear the air for families in the sense that if they are screened for the condition, they may be reassured, or if they have it they can be helped. Screening does save lives.”

(By Claire O’Connell)

(Irish Times, 28 November 2006)

The happiness of Ian and Carolyn McCall in seeing their son write a new page in the Royal’s rugby history books turned to heartache in South Africa. The community was stunned, a family was devastated. But the McCalls decided that John’s death to cardiomyopathy – a disease of the heart muscle which very often affects young people – should help others. Joining with those who have similarly suffered, this saw the formation of a local CRY (Cardiac Risk in the Young) group and, last Wednesday, Northern Ireland’s first independently funded heart screening clinic was launched.
“What we are about is raising awareness of sudden cardiac death and trying to raise funds for the use of raising awareness,” explained Mr McCall. “We could try and held and support people who have been through a similar situation to ourselves.
“Our mission statement is ‘through information and communication to raise and increase knowledge about life-threatening cardiac conditions that affect young people. Our aim is to make screening accessible to young people across Northern Ireland’. That’s what we are about as a group.”

CRY has now established the clinic at Jordanstown; while the group has provided the equipment, the University of Ulster provides the facilities and the staff. It will operate once a month – possibly extended, as and when the need arises. And it could offer a lifeline to many young people who do not yet know they have a heart complaint. Treatment is possible if complaints are diagnosed.

Said Mr McCall: “The results of the screening are e-mailed to London, where CRY has a resident cardiologist, Dr Sanjay Sharma, who will read them and advise on a course of action if need be. This is up and running now. If you went to get screened today, you would find it difficult on the National Health, where you would just join the waiting list.

“If you were to go private, it could cost you up to £350. Sometimes that can be off-putting. We can offer subsidised screening of £35 per person. According to Dr Sharma, there are over 2,000 – and probably more – young people walking around with a possible heart complaint. The sad thing is that with the heart, because it is a major organ, if there is a problem it can result in fatalities, so you don’t have room to wait.”

Indeed, waiting is simply not an option, according to McCall, who feels that all young people in the 12 to 20 age bracket – regardless of fitness and lifestyle – should be tested.

Shortly after John died, the coach of the Portora Royal School rugby team decided to have his young players screened before embarking on a tour of Australia. One of the schoolboys was diagnosed with a heart complaint and, while he still attended the tour, was told not to play any sport.

Mr McCall went on: “He went back to school in September and, one Saturday, when just knocking about with a tennis racket, he dropped dead. Unfortunately it was too late. The health system let him down.

“With the likes of cancer and leukaemia, there are so many different problems to look at. I fully understand that in the grand scheme of things, sudden cardiac death is down the line a bit. But that needs to change.

“We know as a family what it can mean to lose someone this way. It’s almost like a thief has come into your house and stolen your son or daughter.

“We hope that, through this joint venture with the University of Ulster, we can stop this happening and raise awareness. We only hear of the John McCalls and Cormac McAnallens because they are high profile people. Since then there have been a number of families in the Armagh area who have experiences sudden cardiac death. It’s the high profile cases like John and Cormac that bring it to people’s minds. This initiative has come too late for the families in CRY. Before John died we as a family knew nothing about sudden cardiac death, but we now know that we can help stop other families from suffering.

“The burden of grief never leaves. It’s two-and-a-half years since John died. But you never come to terms with the death of a young person. It’s against the grain. Having this knowledge and being involved with this group and running it in some way softens the grief. I would love to be able to say it takes away the grief, but it doesn’t. It softens it.”

There’s an urgent message in his words that is echoed by each and every member of CRY who, through their own personal losses, want others to take note.

“We would advise parents of anyone of secondary school age to get their children screened,” Mr McCall added. £I can’t say that enough. It’s not difficult, it only takes about 20 or 25 minutes.

“Young people who are doing sport are doing quite a bit of sport. They have a bigger sporting agenda than I did when I was at school 30 years ago. If there is a problem with someone’s heart then the pressure of the extra sport can bring that to the fore, and in the majority of times that can lead to sudden cardiac death.”

Of course, screening is something which CRY believes should be done as a matter of course, with much greater emphasis being put on getting the message across. Mr McCall explained: “Italy is the only European country which screens all children as a matter of policy and they have the lowest incidence of sudden cardiac death. CRY as an organisation believe that the statistics are a lot higher than the Government would say.

We have been trying to get them to introduce screening in all secondary schools. We don’t hear of all the deaths. John’s death and Cormac’s death has kicked off a lot of interest in Northern Ireland and has helped get this deal going with the University of Ulster. We want to put it out there to the people of Northern Ireland, whether in Castlederg or Warrenpoint, Ballymena or Fermanagh. If someone hears of someone coming home from school saying ‘’m having dizzy spells’ or ‘I’m feeling faint’, it sets alarm bells ringing. We need to get them screened.

“We beat ourselves up as parents because we though we should have seen something wrong with John.

“The match in which John died wasn’t that intense. The game was start and stop. John died about 22 minutes into the game. About 10 days before he had been playing for the Royal School when they won the Schools’ Cup. We thank God he didn’t drop dead that day. We thank God it was during the international match. That in itself has helped raise awareness. If he had dropped dead in the garden it would not have had the same impact.

“We’ve got to use his death so that we can avert other families from the same fate. Parents must listen and they must take action.”

The first ECG clinic will be held at the University of Ulster at Jordanstown on Saturday, 25 November. For an appointment, contact the CRY Northern Ireland Screening Administrator on 01737-363222.
(By Richard Burden)

(Ulster Gazette, 9 November 2006)

A further defibrillator will be located at the Mid-Ulster Sports Arena in the town.

The Automated External Defibrillators (AEDs) have been supplied by the Cormac Trust which was set up in memory of Tyrone GAA captain Cormac McAnallen who died suddenly because of a heart condition in 2004.

The defibrillators are already available to a range of sports clubs across Tyrone, and in expansion to the scheme, defibrillators are now being installed in town centres throughout Tyrone so they can be accessed seven days a week by volunteers. The initiative is by Cookstown District Council in partnership with the Cormac Trust and the Health Action Zone.

Cookstown District Council and Cookstown Town Centre Forum are seeking volunteers from local businesses in Cookstown town centre to train in the ise of the AED to use in the event of a cardiac arrest occurring in the town centre.

“A patient’s chance of survival reduces every minute that passes, meaning that a defibrillator clost at hand could make all the difference, particularly in a busy town centre such as Cookstown,” said Chairman of Cookstown District Council, Cllr Pearse McAleer.

He said that Cookstown District Council is extremely pleased to be part of the initiative.

“I would encourage volunteers from the business community in the town centre to come forward and be trained in the use of the AED,” he said.

Three to four hours’ training is required to become competent in the use of AED, which involves a range of CRP, basic life support and defibrillator training. A refresher course is also required every 12-24 months. Training involved will incur no cost to volunteer businesses.

Terry Scullion, Cookstown Town Strategy Manager said: “As many as one in five people who have a cardiac arrest do so in a public place and therefore stand to benefit from the ‘Defibrillators in the Community’ programme.

“I would encourage business owners in Cookstown, particularly those in close proximity to the Burnavon Arts & Cultural Centre who want to become a volunteer to contact me.”

(Tyrone Courier, 8 November 2006)

First long-term assessment of program impact
Corrado et al explain that a nationwide screening program for athletes, based on 12-lead ECG, was launched in Italy in 1983. This is the first assessment of the long-term impact of the program on mortality from sudden cardiovascular death, they note.
They analyzed the changes in incidence rates and causes of sudden cardiovascular death among 42 386 young athletes (aged 12 to 35 years) undergoing preparticipation screening in the Veneto region of the country between 1979 and 2004.
During the study period, the annual incidence of sudden cardiovascular death in athletes plummeted by 89%, from 3.6 per 100 000 person-years in 1979-1980 to 0.4 per 100 000 person-years in 2003-2004 (p for trend <0.001), whereas the incidence of sudden death among the unscreened nonathletic population did not change significantly during that time
Compared with the period immediately prior to screening (1979-1981), the relative risk of sudden cardiovascular death was 44% percent lower in the early screening period (1982-1992) and 79% percent lower in the late screening period (1993-2004).
Most of the reduced death rate was due to fewer cases of sudden death from cardiomyopathies.
“All these findings suggest that screening athletes for cardiomyopathies is a lifesaving strategy and that 12-lead ECG is a sensitive and powerful tool for identification and risk stratification of athletes with cardiomyopathies,” the authors write.
In a second, parallel study, they identified 879 athletes (2%) during the study period who were disqualified from competition due to cardiovascular causes, including 60 who had cardiomyopathies.

US docs cite limitations, but Italians beg to differ
But in their editorial, Thompson and Levine say there are a number of limitations to this research. First, this study was not a controlled comparison of screening vs nonscreening of young athletes, “but rather a population-based observational study.” Second, “the authors attribute their success to the routine use of ECGs, but this component was not examined separately and directly, making it impossible to determine if the ECG added to the other components of the examination,” they state.
Third, the annual death rate before the screening program began was 1 per 27 000 athletes, “which is high compared with other [US] studies.” Although the death rate did decrease progressively over time, it was in comparison with this seemingly high initial rate, they point out.
However, the Italian doctors beg to differ. In e-mail correspondence with heartwire, Corrado and senior author Dr Gaetano Thiene (University of Padua) say the mortality rate would be higher in the Italian athletes because they were older (up to 35 years) and more likely to be male than the participants generally included in US studies. Both of these demographics “make for a higher risk of sudden death during sports than that of US high school and college athletes,” they note.
Thompson and Levine also point out that the lowest annual death rate achieved with screening in this study was 0.4 deaths per 100 000 person-years, which is similar to the rate reported for high school and college athletes in the US between 1983 and 1993. “Such results suggest that the less formal screening process practiced in the US at that time may have been as effective as the more formal Italian program.”
But Corrado and Thiene say the mortality rate in the US study referred to above “is likely underestimated due to unavoidable limitations inherent to their retrospective study design.”

What to do with those in whom an abnormality is identified
The editorialists are also concerned about the 2% of athletes banned from sports in the Italian study and say this figure is high compared with studies in US high school and college athletes, which have identified potentially lethal cardiac conditions in only 0.4% to 0.5%.
They note that none of the cases of sudden death in the nonathlete group were former athletes who had been barred on cardiovascular health grounds. “The absence of deaths in disqualified athletes . . . raises the question as to whether [they] were truly at risk for an exercise-related cardiac event. It seems unlikely that all of these screened-out athletes immediately adopted a sedentary lifestyle to avoid the risk of sudden death.”
But Corrado and Thiene say their parallel study “undoubtedly showed that the downward trend of fatal events from cardiomyopathies paralleled the concomitant increase in the number of athletes with cardiomyopathies successfully identified and hence disqualified from competition over the screening periods.”

.

“Identification of young individuals with cardiomyopathies is lifesaving not only due to restriction from competitive sports, but also thanks to the subsequent clinical management aimed to prevent cardiac arrest (close clinical follow-up, beta-blocker therapy, and ICD).”
And the Italian doctors note that the number considered at risk of lethal sudden death in their study was in fact similar to the figures quoted for the US (not more than 0.5%) and agree that excluding many other individuals with nonlethal diseases from competition “is more arbitrary and not as productive.”
They conclude: “Our study may have significant implications for designing more focused screening strategies as well as for modifying disqualification criteria and management of young competitive athletes with cardiovascular diseases.”

Screening: Not always a black-and-white issue
“It’s hard to convince people there is a downside to screening, but there is,” Thompson told heartwire. He illustrates the dilemmas faced by doctors with a personal tale.
“I saw a young boy recently, a promising football player and star high school athlete, whose father played sports all his life but was found to have hypertrophic cardiomyopathy at age 45. We screened the boy and found he had the same cardiomyopathy. What do we do now? The mom said she wishes they’d never had him screened. She was crying, the dad was crying, and the kid was crying, saying that he lives for football. I’m worried about the kid being suicidal.”
Thompson says such an individual is unlikely to have any symptoms but could suffer sudden cardiac death. “What I will probably do is put in an ICD and say you can play some sports. But that’s a $35 000 piece of equipment. Will he ever need it? We don’t know.”

Sources

1.    Corrado D, Basso C, Pavei A, et al. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. JAMA 2006; 296:1593-1601.
2.    Thompson PD and Levine BD. Protecting athletes from sudden cardiac death. JAMA 2006; 296:1648-1650.

By Lisa Nainggolan

(October 3, 2006 )

CENTENNIAL – Few in the NHL played with as much heart as Steve Konowalchuk, making the reason he is giving up the game at age 33 so painfully ironic.
Diagnosed with long QT syndrome, a rare hereditary disorder of the heart’s electrical system, the Avalanche forward Friday announced his retirement.
The condition was detected during an electrocardiogram administered Sept. 14 as part of the routine physicals that all players are given before training camp.
Konowalchuk underwent additional tests at the University of Rochester Cardiac Center, a research center for the syndrome, after which he was strongly advised by doctors to retire.
Calling the past few weeks “very stressful,” Konowalchuk said he had little choice but to hang up his skates after 13 NHL seasons because of the risk involved with playing such an intense sport, especially when he has a wife and two young children.
“I certainly don’t want to go out and play a hockey game and have my wife or my children wondering what the risk is, whether it’s 1 percent, 10 percent or half a percent,” he said during a news conference at the South Suburban Family Sports Center.
Only a few feet away, as Kono- walchuk spoke, the Avalanche practiced in preparation for its preseason finale tonight, against the Los Angeles Kings at the Pepsi Center. The regular season begins next week.
“Watching hockey is going to be hard,” he said. “Two weeks ago I was ready for training camp. I was ready to put a season together and continue my career.”
It was the third low blow in less than two years for Konowalchuk, who missed the final 61 games last season because of a wrist injury that required surgery. He and every other NHL player lost out on the entire 2004-05 campaign, canceled by commissioner Gary Bettman because of a labor dispute.
“As much as I feel I’ve been gypped out of a couple of years, I was still able to put a fairly long career together and accomplished some goals, proving that I can be a player, so I won’t be chasing those demons my whole life,” said the Salt Lake City-born Konowalchuk, who totaled 171 goals and 225 assists in 790 NHL games and played for the U.S. in two World Cups and two World Championships.
Dr. Steve Friedrich, the Avalanche’s cardiologist, said he believes the risk of playing with long QT syndrome is “relatively low,” but that it was necessary for Konowalchuk to be evaluated by physicians who specialize in the disorder.
“Their impression,” Friedrich said, “was that he still is at some low level of risk, and that’s a risk he shouldn’t take.”
Avalanche general manager Francois Giguere said Konowalchuk would be paid his full salary of $1.9 million, and he has been offered an as yet undetermined position in the organization.
“One thing that was clear, every doctor that saw Steve said he shouldn’t be playing,” Giguere said. “I told him, ‘If I was your older brother, there’s no doubt in my mind what the decision has to be.’ ”
Friedrich said the disorder is one that doctors screen for when judging whether someone should be playing sports.
“It’s something that you’re born with, but it doesn’t always show up (on an EKG),” he said. “In Steve’s case, he’s been looked at every year for a long period of time and it has not shown up previously. It clearly did show up this time, and the fact that it runs in his family was a concern.”
Konowalchuk can be treated with medication, and he is expected to be able to live a full, normal life as long as he doesn’t undertake any activity that’s deemed too strenuous.
“This is an absolute surprise,” he said of his medical condition. “I had been skating and training as usual and getting in shape for camp. I’ve had EKG’s every year of my career and they’ve all been very good. For whatever reason, it turned up now.”
Konowalchuk, who said another family member has the condition, was concerned he might have passed it on to his children – ages 8 and 6 – because it is hereditary. He was greatly relieved when both were tested and found to be free of it.
“The first thought was my children,” he said. “That was the biggest stress. At that point, I didn’t worry about hockey. Once we dealt with that – everything seems to be very good there – the next thing I know, wow, I’m dealing with not playing hockey.”
Athletes in several sports have been diagnosed with heart problems over the years, the most serious in hockey involving Detroit Red Wings defenseman Jiri Fischer, who last year collapsed on the bench during a game and had to be resuscitated using CPR and a defibrillator.
Fischer, 25, recovered from the incident but hasn’t played since.
Konowalchuk remembers it all too well, having seen it unfold on television.
“You felt like throwing up,” he said. “You think that could be anyone of us. Here I am later being told I’m putting myself at risk to play. As much as you want to play, it’s pretty easy to put it in perspective. It’s just a game, and there’s a heck of a lot more than playing a game.”
Avalanche coach Joel Quenne- ville and his players feel badly for Konowalchuk, who has been an energy-driven forward and a team leader. He played parts of 12 seasons with the Washington Capitals and was their captain when the Avalanche acquired him in October 2003 for Bates Battaglia and prospect Jonas Johansson.
“You know how badly he wants to play,” Avalanche captain Joe Sakic said. “These last couple years, with the lockout, and he was out (most) of last year . . . he worked so hard to get back. It’s unfortunate news.
“But it’s better to find it now. Safety comes first, and your family comes first. Obviously, it’s a decision you support and respect.”
MAY SURGERY: Another Avalanche forward, Brad May, underwent reconstructive shoulder surgery and will be sidelined four to six months. He was injured in a fight with Detroit’s Darryl Bootland in a preseason game Monday.
Heart matters
Long QT syndrome, the condition that forced Avalanche forward Steve Konowalchuk to retire at age 33, “is a genetic disease involving electrical conduction which can lead to irregular heart rhythms,” team cardiologist Dr. Steve Friedrich said.
• It is a rare disorder, Friedrich said, affecting one in 10,000 people, but the odds increase to one in two persons in a family when one member has the condition.
• According to the American Medical Association, the heart, when it contracts, emits an electrical signal that can be recorded on an electrocardiogram (EKG). It produces a characteristic wave form designated by letters – P, Q, R, S and T. The QT interval represents the time for electrical activation and inactivation of the ventricles, the heart’s lower chambers.
• The time it takes for the QT interval to occur can be measured in fractions of a second. If it takes longer than normal, it’s called a prolonged QT interval.
People with the disorder are susceptible to an abnormally rapid heartbeat (arrhythmia), meaning the heart muscle can’t contract effectively and the normal volume of blood is reduced to the body and to the brain. If the brain is starved of oxygen, the person faints within seconds.
• If the heart can’t regain its normal rhythm, it can go into spasms that lead to a deadly arrhythmia called ventricular fibrillation. Without immediate emergency treatment, death follows within minutes.
• People with this condition may show prolongation of the QT interval during physical exercise or intense emotion, which is why Konowalchuk shouldn’t participate in a high-speed sport like hockey.
• Treatments for the condition include medication, though sometimes a surgical procedure is needed.
Friedrich said he expects Konowalchuk “to live a very normal life with very minimal restrictions in activities.”
He just can’t play hockey.

26 September, 2006.

The new rules, developed over the past year, were sent to teams this summer but were not publicized. The move is viewed as a significant step toward preventing heart-related deaths on the court. The N.B.A.’s program is the most extensive among the four major American sports leagues.

”The standardized and systematic strategy that the N.B.A. is instituting is very reasonable and important,” said Dr. Barry J. Maron, a cardiologist who served on a four-person panel that helped the league devise the program. ”They should be given substantial credit for this initiative.”

League officials said that such an initiative had long been discussed. But they were spurred to act by two disturbing events last fall. On Oct. 15, Jason Collier, a 28-year-old center for Atlanta, died of an abnormally enlarged heart.

Relatives said Collier had been unaware of any heart problems.

Two weeks earlier, the Chicago Bulls traded center Eddy Curry, then 22, to the Knicks because of concerns that he might be predisposed to a potentially fatal heart condition. The Knicks, after consulting numerous cardiologists, concluded that Curry was not at risk.

Doctors and league officials concede that the new protocols would not necessarily have prevented Collier’s death, or averted the awkward controversy surrounding Curry. The new rules do not require that a player be barred from playing based on his test results, for example. In the case of Curry, experts with divergent philosophies might still reach different conclusions about whether he should continue playing.

But the league’s decision to mandate a number of tests — which exceed the American Heart Association’s 12-point program — should help.

”It’s far beyond what we do for college athletes and for high school athletes,” Dr. Craig Asher, a cardiologist at the Cleveland Clinic in Weston, Fla., said. ”It should pick up most of the main causes of sudden cardiac death in athletes.”

The N.B.A.’s screening process will include a physical examination, blood work and three heart tests: an electrocardiogram, a resting echocardiogram and a stress echocardiogram. Players will also be asked to provide personal and family medical histories to determine predisposition to certain heart problems.

The tests will be administered annually and must be completed before a player can participate in training camp. This year, most players will be tested Oct. 2 or 3, before camps open.

Neither Major League Baseball nor the National Hockey League has a uniform leaguewide heart screening program. The National Football League mandates a cardiovascular exam, including an EKG, as part of annual physicals, but does not require an echocardiogram unless other test results suggest that one is needed.

Previously, the N.B.A. allowed its 30 teams to set their own parameters for cardiac screening. The Curry controversy illustrated the need for a uniform approach.

”Every team had a sensible program in place,” Joel Litvin, the N.B.A.’s president for basketball operations, said. ”There was nobody who we thought was deficient. But we thought it made sense, after talking to our experts, to have one standard set of tests that we all used.”

John Paxson, the Bulls’ general manager, expressed concern last fall that Curry might be at risk for hypertrophic cardiomyopathy, or HCM, the most common cause of sudden cardiac death in young athletes. Curry had two bouts with an irregular heartbeat with the Bulls.

Both Paxson and Maron, who is the director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation, advocated that Curry undergo a genetic screening test to help rule out HCM. Curry’s refusal led to the trade.

The N.B.A.’s new policy does not call for genetic testing, and Maron said he did not push for it.

Paxson declined to comment on the new program. Through a team spokesman, the Knicks’ physician, Dr. Lisa Callahan, expressed support for it.

Litvin said the expert panel that helped develop the new protocols could be consulted to help interpret test results.

”But you’ll never eliminate the possibility of a disagreement on how doctors read test results,” he said.

Heart concerns were prominent across the league last season. Four players needed heart surgery to correct various abnormalities — Ronny Turiaf of the Los Angeles Lakers, Fred Hoiberg of the Minnesota Timberwolves, Zeljko Rebraca of the Los Angeles Clippers and Robert Traylor, who last played for Cleveland in 2004-5.

One of every 200,000 to 300,000 young athletes suffers sudden cardiac death each year, Asher said. But studies estimate that 1 in 500 people have HCM. Not all of them are in the high-risk group for sudden cardiac death, but athletes with HCM are generally advised to avoid impact sports.

The tests mandated by the N.B.A., particularly the electrocardiograms and echocardiograms, should detect almost all cases of HCM, said Asher, who is on the advisory committee for the Hypertrophic Cardiomyopathy Association.

Once a player receives a diagnosis of HCM, the more difficult task is determining the level of risk and whether he should continue playing.

”There will be many athletes that will fall into a gray zone,” Asher said. ”I think it’s going to get messier, because we’re still learning a lot about how the heart changes with sports, and we’re going to have more people like Eddy Curry and Reggie Lewis, where we’re just not certain what the risk is.

And in the end, there’s not always a gold-standard test to say that you do have the disorder or you don’t.”

By Howard Beck & Michael S. Schmidt (The New York Times, September 17, 2006)

Cora J. Houdersheldt and David Sines were represented by Cumberland attorneys Jason C. Buckel and S. Ramani Pillai in a jury trial for the civil case presided over by Judge W. Timothy Finan.

Kelly Sines was in science class April 12, 2002, when she got up to turn in a test or quiz and collapsed, according to Greg Smith, then principal at Beall High.

The state medical examiner later named the cause of death as cardiac arrhythmia, a change from the normal rate or control of the heart’s muscle contractions. She was not on drugs and there was no evidence of foul play, according to C3I investigators.

According to previous reports in the Times-News, Smith said an emergency medical technician was on staff and was able to begin working on Sines just after she collapsed. She reportedly collapsed at 1:37 p.m. and members of the crisis response team were in the school by 1:45 p.m.

Buckel and Pillai said in a press release Tuesday that Sines died as a result of negligence by the Allegany County Board of Education.

“At that time, Allegany County schools did not have automated external defibrillators and, as a result, school personnel trained in CPR and in how to use a defibrillator were unable to utilize the only medical device which could have saved Kelly’s life,” according to Buckel and Pillai.

“Significantly, the jury found that a substantial period of time went by from the moment of Kelly’s collapse until school officials notified appropriate emergency medical personnel,” according to the attorneys.

“The delay caused or contributed to Kelly’s death, as Dr. Larry Rhodes, the chief of pediatric cardiology at West Virginia University Hospital testified …” and … “that Kelly had a high probability of survival if she had been defibrillated within a 6- to-8-minute window from the time of her collapse,” Buckel and Pillai said.

The Cumberland attorneys noted that the Allegany County school system did not have a legal obligation to provide AEDs in the schools as of April 2002, however, in the 2006 legislative session, the Maryland General Assembly passed a law requiring all school systems in the state to have automated external defibrillators in their school buildings.

The Allegany County Board of Education was represented by Timothy E. Fizer of the Baltimore firm Krause, Fizer, Crogan and Lopez.

Defendants initially included Smith, Beall High School, Superintendent Bill AuMiller and Allegany County.

By Alison Bunting
(Cumberland Times-News, 6 September 2006)

Twice this 18-year-old from Penfield has been hit by the lightning bolt of misfortune. Twice her heart has stopped beating, and twice someone with medical training has been there to bring her back from the grip of death.

Parker, a freshman, has been told countless times by doctors, friends, relatives and perfect strangers just how lucky she is to be alive.

But for the teenager, thinking about the thin wire she has walked between life and death is not easy.

“It’s hard to comprehend all of it,” Parker said. “You think ‘Oh my gosh.’ But if I think about it, I think I really am lucky.”

Heart-stopping story

Donna and Joe Parker dropped their daughter off at Ithaca College on Aug. 27 with trepidation. Like other parents, there was the natural concern about sending their child off to college for the first time. But the couple had more of a burden that day than many of the other parents.

Just seven days before, Allison had been lying in a hospital bed after her heart stopped while she was exercising at a local athletic club. It was only the quick thinking of a doctor working out at the club and the presence of an automatic external defibrillator in the building that saved her life.

“Everyone who came into the room looked at Allison and said, ‘You don’t know how lucky you are,’” said Donna Parker. “We are just blessed. Totally.”

Allison goes to the gym about three times a week. She was on the Penfield High School alpine skiing team for four years and also liked to play recreational softball. On Aug. 20, she was at the Mid-Town Athletic Club, working out on a cross-training machine, when she began to feel lightheaded.

“Within the first 10 minutes of working out, I stopped to catch my breath and I couldn’t,” Allison said. “I just stepped off the machine and leaned against the side and got these little black dots in my vision, so I just closed my eyes. When I opened them again, everything was black.”

The next thing she remembers is waking up and being surrounded by people. She does not know how long she was out.

Dr. Frank Zwemer was in another room at the club, about 45 minutes into a spinning class. The music was loud, and Zwemer and his classmates were pedaling hard on their stationary bicycles.

He said he saw some commotion in the workout room but did not know what was happening until his wife, Laura Brewer, came into the spinning class and told him club officials were calling over the public address system for a doctor.

“I basically found this woman at the foot of an exercise machine, kind of in a pile with all these people around her,” he said. “She looked basically dead or near dead.”

Having Zwemer in the building was a stroke of luck for Allison. Not only is he an emergency room physician, but he is the clinical director of the Emergency Department at Strong Memorial Hospital.

When he got to Allison, she was taking the kind of gasps that people take just before they die, he said. She had stopped breathing and had no pulse.

“I was feeling for a pulse. I was asking for help finding a pulse, and no one could find a pulse,” Zwemer said.

He said he told somebody to call 911 and he and another bystander started CPR. After several minutes, Allison still had no pulse. Zwemer said someone brought him the club’s emergency defibrillator kit.

“Once we hooked her up to it and turned it on, it signaled for a shock and we shocked her,” he said. “With that one shock, she had a pulse.”

The first lucky strike

Allison survived a similar incident two years ago while hiking in the Adirondack Mountains with a group of summer campers. Miles away from emergency medical care, her life was saved by a nurse who was with the group.

“I was on a hike, and again within the first 10 minutes of hiking, I leaned up against a tree — this is what I’ve been told because I don’t remember any of this — and then just fell,” she said. “Luckily, there just happened to be a nurse on the hike, and she gave me CPR for about 20 minutes until an ambulance got there.”

Allison was unconscious for two days and spent nine days in the hospital. Doctors, however, could not determine why her heart simply stopped beating.

“We walked away scratching our heads, not knowing what it was, a mineral deficiency or something else,” said Allison’s mother. “It was very unsettling.”

Off to school

The good thing to come from the recent attack was that it allowed doctors to finally pinpoint the cause. After Allison was revived at the health club, she was taken to Strong, where doctors determined after a battery of tests that her heart stopped because of a condition called hypertrophic cardiomyopathy. The disease is inherited and causes a thickening of the heart muscle.

Donna Parker also has hypertrophic cardiomyopathy, but she has never experienced attacks as severe as her daughter’s.

Allison left the hospital with a small automatic defibrillator implanted in her chest. It is not a cure, but the device is set to deliver a shock if the heart goes into cardiac arrest.

“They said it will feel like somebody punched me in the chest,” said Allison. “They said if I pass out, I will wake up.”

The device is making it possible for Allison to go to school this fall. Her parents were apprehensive about letting her go, but her determination and doctors’ approvals changed their minds.

“She kept saying, ‘I want to go to school, I want to go to school,’” her mother said. “(The doctors) were the first ones to say she could do that, and it was like her spirits just rebounded. I guess it’s her determination.”

Giving thanks

The college student says she is excited about being at school and the classes she is taking. She even walked the treadmill at the school gym last week.

Allison said she thinks about what she has been through and the doctor who saved her life. She said she remembers when he came to visit her in the hospital.

“You could tell he had tears in his eyes,” said Allison. “My mom had to help me talk to him because of the shock of him being there and saving my life. All I could do was like thank him a million times.”

For Zwemer, it was an emotional experience as well. He credits his experience and training. He also is thankful the club had an emergency defibrillator.

“I was on a high for a few days, and particularly because it was a young person’s life,” he said. “What really saved her life was shocking her with the AED, but I think what I was able to offer was just recognizing that this was not just a simple seizure.”

Donna Parker said she just wrote a letter to Zwemer.

“But how do you say thank you? It sounds so trivial compared to what happened,” she said. “I finally got a thank-you note out to him, and it just said, ‘I can’t believe you were a blessing to her on that day.’”

Jeffrey Blackwell
(Drochester Democrat and Chronicle, September 5, 2006)