By Jon Ostendorff • November 27, 2009
CULLOWHEE — Dr. Greg Motley has found hundreds of heart murmurs in his dozen years doing health exams for high school athletes and twice as many cases of high blood pressure.
He even found a case of appendicitis that required emergency surgery the next day.
But the annual exams, required for all North Carolina high school athletes, aren’t designed to catch a serious cardiac problem like the one that contributed to the death of a Western Carolina University football player.
“You can’t hear it,” Motley said Wednesday. “The best option for parents, if they have a concern, is to review the family medical genealogy and, if in doubt, they need to have a full blown workup for the student.”
WCU’s Ja’Quayvin Smalls died during a practice in July from “acute lethal cardiac dysrhythmia due to cardiomyopathy,” according to an autopsy made public Tuesday.
Cardiomyopathy, the thickening of the heart muscle, is the top cause of sudden death among athletes.
Motley, who started Southeastern Sports Medicine 12 years ago, said student athletes shouldn’t rely on the annual screenings. They should have twice annual physicals with a family doctor.
And if anyone in a student athlete’s family has had heart problems at a young age, the student needs to have an echocardiogram.
“Parents need to get involved and look back on your moms and dads,” he said.
Athletes don’t routinely get electrocardiograms or echocardiograms that might detect serious heart problems.
This isn’t unusual. A typical patient, athletic or not, won’t get the test unless he reports symptoms.
High school athletes in North Carolina get a basic health screening every year.
Doctors like Motley check vital signs including temperature and blood pressure, they look for abnormalities that could be signs of bigger problems and they listen to the heart and lungs.
If anything comes up, they refer students to a family doctor for a more detailed exam.
The questionnaire in the second part of the screening — which athletic health experts say is the most crucial — can also be the most problematic.
It relies on parents and students knowing enough about their family medical “genealogy,” as Motley calls it, to accurately answer questions about cardiac, breathing and blood pressure issues.
It also relies on honesty, which can be overcome by the desire to play.
Unless a student reports a symptom or a family history of problems, a more in-depth physical isn’t required.
“I wish they were because the physical is much more thorough,” said John Bryant, the athletic director at East Henderson High School.
He called the screening “a good first step” but said teaching parents, coaches and players to be on the lookout for health problems throughout the season is crucial in making sure students stay healthy.
Should more be done?
It’s a difficult question to answer, athletic health experts said. Smalls, a 20-year-old junior defensive back, collapsed during a sprint workout after complaining of cramps.
His heart was slightly enlarged and he had an irregular heartbeat with premature ventricular contractions during a fever five years ago, according to the autopsy.
Those contractions were a warning sign of a serious condition, said Lisa Salberg, founder of the New Jersey-based Hypertrophic Cardiomyopathy Association.
Sixty athletes die in competition and practices every year in the United States from health problems, said Salberg, who reviewed Smalls’ autopsy.
Cardiac arrest caused by a condition called hypertrophic cardiomyopathy is suspected in one of every three of those deaths. About 30 percent of the athletes with the condition have a heart murmur that could be detected.
Salberg said detailed testing should be required for athletes who are at risk. But finding out who is at risk is the hard part.
An echocardiogram for every athlete, at a cost of hundreds of dollars per exam, probably isn’t the best strategy, Motley and other medical experts say.
Some colleges, following an NCAA recommendation this summer, now require sickle cell trait testing for all African-American athletes.
Sickle cell trait contributed to Smalls’ cardiac arrest, according to his autopsy. WCU started testing athletes for sickle cell trait after Smalls’ death.
The blood test costs $5.
Regular health care
Local high school athletic directors agreed with Motley’s call for parents to take seriously the questionnaires their children are filling out in the screenings every year and consider twice yearly physicals.
Rex Wells, athletic director at Asheville High School, said students with a family history of early onset heart problems should have more tests than the yearly health screening.
The problem, he said, is sometimes parents of teenagers are too young to have had heart problems themselves, and they don’t know enough about their family histories.
Bryant, at East Henderson, meets with players, coaches and parents every year to talk about health and safety issues.
He stresses being aware of symptoms on and off the field. Fatigue, joint pain, heart trouble and dizziness at any time for a student athlete should be reported to coach or doctor.
Coaches, trainers and the annual screening can only go so far, he said.
“I think that is where you hope families are getting regular medical attention, preventative health care,” he said.