Heart failure and student-athletes
About 125 athletes under 35 die each year in the U.S. alone, institute says
Last month, three athletes under 21 died in the span of two days. Nineteen-year-old Mickey Renaud, captain of the Ontario Hockey League’s Windsor Spitfires and a fourth-round pick of the Calgary Flames, collapsed at breakfast Feb. 18; Louisiana high school basketball player Shannon Veal died during a game that night; University of Prince Edward Island student Rene Ayangma died following a mixed martial arts sparring session the next day.
According to the Minneapolis Heart Institute Foundation, which tracks deaths of young athletes in a registry, about 125 athletes under 35 die in the U.S. each year, mainly from cardiovascular problems.
Men’s hockey coach Brett Gibson said Renaud’s death struck close to home.
“Mickey Renaud was a player I was recruiting, actually, to come to Queen’s,” he said. “It’s just devastating, not just to the Windsor Spitfires but to the whole hockey community, any time a fellow colleague goes down. I truly believe he had a special future ahead of him.”
Gibson said it’s possible a similar incident could occur at Queen’s, but the hockey program takes all reasonable precautions to prevent a similar tragedy.
“For sure, any time you step on the ice and play a sport … there’s a concern of death,” he said. “Our trainers and our medical staff do a great job of analyzing our players before the season begins to see where their fitness lies. I don’t think you can control life, but you can definitely be prepared when circumstances arise.”
Gibson said CIS mandates teams conduct extensive pre-season screening to make sure their players are healthy.
“Before anyone takes the ice, they have to meet with our local doctor, Dr. Bagg, and go through a physical training phase with him,” he said. “He determines whether or not they are fit to play.”
Gibson said he isn’t sure if the team could do more to prevent heart attacks.
“I don’t know if it’s enough,” he said. “I know it’s a start. I know our players are in great shape, but that doesn’t mean their heart can’t give out at any time.” Queen’s forward Jon Lawrance said Renaud’s death took him by surprise.
“It’s obviously a shock,” he said. “You figure a guy his age and in that good of shape, he’s probably the least likely to have something like that occur.”
Lawrance said Renaud’s death doesn’t make him worry about playing hockey, though.
“You’re just as likely to have those things happen if you don’t play competitive sports,” he said. “Just because he’s a hockey player, I don’t think that had anything to do with it.” Groups such as the Chase McEachern Foundation, named after an 11-year-old hockey player who died of a heart attack, are lobbying to make defibrillators mandatory in hockey arenas and other venues. Defibrillators have been credited with saving the lives of several hockey players. Most professional teams already have one, and all Canadian Hockey League junior teams are required to have a defibrillator in their building.
Queen’s Athletics Associate Director of Facilities and Business Development Herb Steacy said the Memorial Centre, where the men’s hockey team played most of their games this season, doesn’t have a defibrillator. Steacy said the University hopes to get a portable defibrillator that can be brought to the Memorial Centre for hockey games. It would cost about $2,000.
Steacy said there are already two defibrillators in the PEC—one in the athletic therapy room and one at the equipment counter—and one in Richardson Stadium when they have games there.
Lawrance said he’s in favour of making defibrillators mandatory, and he’s pleased Queen’s is looking into buying one.
“It’s not something you think about, but at the same time, it’s nice to know that if something should happen they have a plan of attack,” he said. “Something like that, you only have a few seconds, and if there’s no resources there, that’s kind of it.”
Dr. Andrew Pipe, the medical director of the University of Ottawa Heart Institute Minto Prevention and Rehabilitation Centre and a member of the Queen’s Board of Trustees, said he wants defibrillators in every exercise venue, not just arenas.
The U.S. National Library of Medicine defines ventricular fibrillation as “a severely abnormal heart rhythm (arrythmia) that causes death unless immediately treated” by delivering an electrical shock to the chest via a defibrillator.
Pipe said his institute’s research reinforces the importance of making defibrillators mandatory, visible and easy to use.
“The good news there is defibrillators today are highly automated,” he said. “You turn them on and they speak to you and tell you what to do, so even a layperson can operate them.”
Pipe said one of the most important ways to prevent heart attacks in athletes is to consider if there’s any history of heart disease in their family.
“Is there any family history of sudden cardiac death?” he said. “Is there any history of young males, and these are usually young males, dropping dead at very young ages, irrespective of whether they were involved in physical activity? … We know that most common causes can be inherited.”
Studies have shown that one in 500 people has a disorder called hypertropic cardiomypathy, and an estimated one in every 15,000 joggers will die from cardiac disease.
Dr. Willem Meeuwisse, a professor at the University of Calgary’s Sport Medicine Centre and a clinical physician who was the Calgary Flames’ team doctor for six years, said every university athlete’s medical history should be investigated before they can begin play, and more detailed physical examinations should be carried out on those with histories of cardiac disease.
“I think every athlete warrants screening with a comprehensive exam of their medical history,” he said. “That’s probably the most important thing.”
Meeuwisse helped develop the standard injury guidelines adopted last year by world soccer’s governing body, the Fédération Internationale de Football Association (FIFA). Four professional soccer players—Spain’s Antonio Puerta, Zambia’s Chaswe Nsofwa, Scotland’s Phil O’Donnell, and Gabon’s Guy Tchingoma—have died within the last year.
Meeuwisse said FIFA’s looking at more systematic screening of players for heart conditions, including using echocardiograms (ECGs), a technique that uses sound waves to form a picture of the heart.
Meeuwisse said using advanced tests like ECGs on young athletes is problematic, though, because of the large numbers of false positive results that approach creates.
“I’m an epidemiologist, I look at the numbers,” he said. “The numbers tell us the risk of a sudden cardiac death in that age group is probably one in 200,000. … We know with the current methods we have, with screening with ECGs, you probably have about a two per cent positive rate. If the rate of sudden deaths is that low, almost all of those are false positives. If you use ECG and then find an abnormality and say you can’t play sports, the question is, are you willing to exclude 2,000 healthy people from playing sports to catch the one that might have a sudden death?”
Director of Athletics and Recreation Leslie Dal Cin said all incoming Queen’s athletes are screened for various medical conditions.
“Because of the confidential nature of the information, it goes directly from the entry into Dave [Ross, co-ordinator of athletic therapy services]’s system, Dave screens it, and then he follows up on any area where he feels there’s a concern,” she said.
Dal Cin said the athletics department doesn’t have the resources to extend that screening to intramural and club participants.
“By its nature, there has to be some assumption of risk by the student who’s participating in the activity,” she said. “I don’t know if we would have the capabilities to manage—I think we have 7,500 people playing in our intramural programs—the information and the testing that would need to accompany that.”
Robert Ross, a kinesiology professor at Queen’s who teaches a course on physical activity and health, said exercise, including sports, is tremendously beneficial for the heart overall.
Ross said he’s worried coverage of sports-related deaths will keep people from exercising, especially those who lead a sedentary lifestyle.
“Before undertaking a program, it’s probably a prudent suggestion to seek the advice of their primary physician, but in the vast majority [of cases], that physician would be delighted with the fact that their patient would be considering participation in a moderately intense physical activity program.”