Sudden cardiac arrest (SCA) can result in the death of individuals who may or may not know of a preexisting heart conditions. Save an Athlete aims to educate student athletes, their families, doctors, athletic directors and coaches about the importance of preventing cardiac arrest through early cardiac testing.

The following are cardiac conditions may by uncovered through primary prevention with cardiac testing:

Cardiomyopathy
Cardiomyopathy is a disease in which the heart muscle becomes inflamed. There may be multiple causes including viral infections. Cardiomyopathy can be classified as primary or secondary. Primary cardiomyopathy can't be attributed to a specific cause, such as high blood pressure, heart valve disease, artery diseases or congenital heart defects. Secondary cardiomyopathy is due to specific causes. It's often associated with diseases involving other organs as well as the heart. There are three main types of cardiomyopathy - hypertrophic, dilated, and restrictive. ^{81, 87,88,89,93,97,98, 100-105}

Hypertrophic Cardiomyopathy (HCM) or Hypertrophic Obstructive Cardiomyopathy (HCOM)
With HCM, the wall, or septum, between the two ventricles (pumping chamber) becomes enlarged and obstructs the blood flow from the left ventricle. The syndrome is known as Hypertrophic Obstructive Cardiomyopathy (H.O.C.M.) or Asymmetric Septal Hypertrophy (A.S.H.) or Idiopathic Hypertrophic Subaortic Stenosis (I.H.S.S.).

Besides obstructing blood flow, the thickened wall sometimes distorts one leaflet of the mitral valve, causing it to leak. In many cases, the disease is hereditary. Close blood relatives (parents, children or siblings) of such persons often have enlarged septums, although they may have no symptoms. This disease is most common in young adults.

In the other form of the disease, non-obstructive Hypertrophic Cardiomyopathy (HCM), the enlarged muscle doesn't obstruct blood flow.

The symptoms of Hypertrophic Cardiomyopathy include shortness of breath on exertion, dizziness, fainting and chest pain or discomfort. Some people have cardiac arrhythmias. These are abnormal heart rhythms that in some cases can lead to sudden death. The obstruction to blood flow from the left ventricle increases the ventricle's work, and a heart murmur may be heard.

Hypertrophic Cardiomyopathy paper, Barry Maron, M.D.

Dilated Cardiomyopathy (DCM)
Dilated Cardiomyopathy (DCM) is a condition in which the heart's ability to pump blood is decreased because the heart's main pumping chamber, the left ventricle, is enlarged and stiff; this causes a decreased ejection fraction (the amount of blood pumped out with each heart beat). In some cases, it prevents the heart from relaxing and filling with blood, as it should. Over time, it can affect the other heart chambers as well.^{108, 109}

Restrictive Cardiomyopathy
A Restrictive Cardiomyopathy, the rarest form of cardiomyopathy, is a condition in which the walls of the lower chambers of the heart (the ventricles) are abnormally rigid and lack the flexibility to expand as the ventricles fill with blood.¹¹⁹

Left Ventricular Hypertrophy (LVH)
Left Ventricular Hypertrophy (LVH) is an enlargement of the left pumping chamber of the heart and may be due to several different things. The most common cause is high blood pressure. Other causes are due to exercise (athletic hypertrophy) and congenital HCM or HOCM.

Arrhythmogenic Right Ventricular Dysplasia (ARVD)
Arrhythmogenic means causing an arrhythmia. The right ventricle is the chamber of the heart that is affected and dysplasia means there is an abnormality of the structure. ARVD is a specific type of cardiomyopathy (a disorder of the cardiac muscle).

Simply put, ARVD is a genetic, progressive heart condition in which the muscle of the right ventricle is replaced by fat and fibrosis, which causes abnormal heart rhythms. ARVD is estimated to affect one in 5,000 people. The disease can affect both men and women. Although it is a relatively uncommon cause of sudden cardiac death, it accounts for up to one fifth of sudden cardiac death in people under 35 years of age.¹¹⁹

Long QT Syndrome
Long QT Syndrome is an inherited defect in heart rhythm that predisposes to syncope (sudden fainting spells) without warning, dizziness, palpitations, seizures and sudden death. The name of the syndrome comes from the QT segment on the electrocardiogram (ECG). This segment lasts slightly longer in the syndrome than normal. The heart takes longer to recharge itself between beats. Certain conditions can trigger an abnormal cardiac rhythm. Among the known triggers are intense physical exercise, swimming, being suddenly startled or badly frightened.

With Long QT, the potassium channels do not behave as efficiently as would normally, or the sodium channel over-activates. This results in an electrical disturbance in the cell called prolonged repolarisation. This can be reflected on the ECG as lengthening of the time period known as the "QT interval", hence the name, Long QT Syndrome. This is also known as the Romano Ward Syndrome (the common form) and Jervell Lange-Neilsen Syndrome (a rare form associated with deafness).⁵⁸

Wolffe-Parkinson-White Syndrome (WPW)
Wolffe-Parkinson-White syndrome (WPW) is an abnormality of the heart's electrical system. People with WPW have an extra electrical connection between the atria (the upper chambers) and the ventricles (the lower chambers). This abnormal electrical connection can cause episodes of rapid heart rhythms called paroxysmal atrial tachycardia, preexcited tachycardia, or preexcited atrial fibrillation.

The syndrome usually occurs without other heart abnormalities. However, WPW has infrequently been associated with rare heart conditions such as Ebstein's anomaly and hypertrophic cardiomyopathy.⁶⁰

Marfan Syndrome
MarFan Syndrome is an inherited genetic disorder of the connective tissues. Marfan Syndrome affects many organ systems, including the skeleton, lungs, eyes, heart, and blood vessels. The condition can affect both men and women of any race or ethnic origin. Connective tissue is tissue that connects or provides structural support, and also determines the elasticity of the body's organs, bones, and ligaments. Marfan Syndrome is characterized by stretching and weakening of the connective tissues in the heart, lungs, eyes, and skeletal system. Marfan's syndrome is frequently recognized in people with longer arm wing spans than height,vision problems, and tapered fingernails.

Myocarditis
Myocarditis is inflammation or degeneration of the heart muscle. Myocarditis may be a complication during or after various viral, bacterial, or parasitic infectious diseases, such as polio, influenza, rubella, or rheumatic fever. It is often caused by various diseases such as syphilis, goiter, endocarditis, or hypertension, however, myocarditis may appear as a primary disease in adults or as a degenerative disease of old age. It may be associated with dilation (enlargement due to weakness of the heart muscle) or with hypertrophy (overgrowth of the muscle tissue). In some cases, myocarditis may progress to congestive heart failure.

Atrial Septal Defects (ASD)
ASD are a group of congenital heart diseases that enables communication between atria of the heart and may involve the interatrial septum. The interatrial septum is the tissue that separates the right and left atria from each other. Without this septum, or if there is a defect in this septum, it is possible for blood to travel from the left side of the heart to the right side of the heart, or the other way around, resulting in mixing of arterial and venous blood.⁵⁵

Since the right side of the heart contains venous blood with a low oxygen content, and the left side of the heart contains arterial blood with a high oxygen content, it is beneficial to prevent any communication between the two sides of the heart and prevent the blood from the two sides of the heart from mixing with each other.

Brugada Syndrome
The Brugada syndrome is a genetic disease that is manifest by abnormal electrocardiogram (ECG) findings and an increased risk of sudden cardiac death. This condition was first identified and then further clarified from the late 1980's onwards. It is a rare condition in the western world that appears to be considerably more common amongst young men in South East Asia. It is also known as "Sudden Unexpected Death Syndrome" (SUDS). It has very recently been associated with mutations in the sodium channel, but this appears to only account for 20% of sufferers. The sodium channel behaves abnormally in that movement of sodium ions into the cells is restricted. This results in changes on the ECG, but no abnormalities in the structure of the heart. ^62,68

Kawasaki Disease
Kawasaki disease is a children's illness. It's also known as Kawasaki syndrome or mucocutaneous lymph node syndrome. Kawasaki disease and acute rheumatic fever are the two leading causes of acquired heart disease in children in the United States. About 80 percent of the people with Kawasaki disease are under age five. Children over age eight are rarely affected. The disease occurs more often among boys (over 60 percent) and among those of Asian ancestry. But it can occur in every racial and ethnic group.

Doctors don't know what causes Kawasaki disease, but it doesn't seem to be hereditary or contagious. Scientists who've studied it think the evidence strongly suggests it's caused by an infectious agent such as a virus. It's very rare for more than one child in a family to develop Kawasaki disease. Less than 2 percent of children have another attack of Kawasaki disease. In as many as 15 to 25 percent of the children with Kawasaki disease, the coronary arteries or the heart muscle can be damaged. Part of a coronary wall can be weakened and balloon in an aneurysm. A blood clot can form in this weakened area and block the artery, sometimes leading to a heart attack. The aneurysm can also burst, but this rarely happens.

Other changes include inflammation of the heart muscle (myocarditis) or the sac surrounding the heart (pericarditis). Arrhythmias (abnormal heart rhythms) or abnormal functioning of some heart valves also can occur. Usually all the heart problems go away in five or six weeks, and there's no lasting damage. Sometimes coronary artery damage persists, however. ^71,73

This and more information related to cardiac conditions can be found at www.AmericanHeart.org

55 Hiromi Muta, MD, et. al, "Incidence and Clinical Features of Asymptomatic Atrial Septal Defect in School Children Diagnosed by Heart Disease Screening," Circulation Journal, Vol 67, February 2003, Pages 112-115. (notebook 3)
58 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
60 Donna L. Provenzano, MS, "A Review of Wolff-Parkinson-White Syndrome in Athletes," American College of Sports Medicine's Certified News, Volume 13, number 2, April-June 2003.
61 Sandeep Jauhar, "Out of the Blue, A Lightning Bolt to the Heart," New York Times, February 10, 2004. (notebook 3)
62 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
63 Sandeep Jauhar, "Out of the Blue, a Lightning Bolt to the Heart," New York Times, February 10, 2004. (notebook 3)
65 Sandeep Jauhar, "Out of the Blue, a Lightning Bolt to the Heart," New York Times, February 10, 2004. (notebook 3)
68 Sandeep Jauhar, "Out of the Blue, a Lightning Bolt to the Heart," New York Times, February 10, 2004. (notebook 3)
71"Kawasaki Disease," OHSU Health Website, www.ohsudoernbecher.com/health/cardiac/kawasaki.asp, accessed March 8, 2005. (notebook 3)
72 "Kawasaki Disease," kidshealth.org, accessed March 1, 2005. (notebook 3)
73 Juan Carlos Rozo, MD, et al, "Kawasaki Disease in the Adult: A Case Report and Review of the Literature," Texas Heart Institute Journal, 2004: 31 (2): 160-164. (notebook 3)
74 Juan Carlos Rozo, MD, et al, "Kawasaki Disease in the Adult: A Case Report and Review of the Literature," Texas Heart Institute Journal, 2004: 31 (2): 160-164. (notebook 3)
87 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
88 Children's Cardiomyopathy Foundation, www.childrenscardiomyopathy.org accessed April 14, 2005. (notebook 3)
89 "Heart Screening for All Young Athletes?" Ivanhoe Newswire, www.ivanhoe.com, February 7, 2005. notebook 3)
91 Children's Cardiomyopathy Foundation, www.childrenscardiomyopathy.org accessed April 14, 2005. (notebook 3)
92 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
93 "Heart Screening for All Young Athletes?" Ivanhoe Newswire, www.ivanhoe.com, February 7, 2005. (notebook 3)
94 Children's Cardiomyopathy Foundation, www.childrenscardiomyopathy.org accessed April 14, 2005. (notebook 3)
97 Children's Cardiomyopathy Foundation, www.childrenscardiomyopathy.org accessed April 14, 2005. (notebook 3)
98 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
100 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
101 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
102 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
103 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
104 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
105 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
106 S.G. Priori et. al., "Task Force on Sudden Cardiac Death of the European Society of Cardiology," European Heart Journal (2001) 22, 1374-1450. (notebook 3)
107 Children's Cardiomyopathy Foundation, www.childrenscardiomyopathy.org accessed April 14, 2005. (notebook 3)
108 Children's Cardiomyopathy Foundation, www.childrenscardiomyopathy.org accessed April 14, 2005. (notebook 3)
109 Children's Cardiomyopathy Foundation, www.childrenscardiomyopathy.org accessed April 14, 2005. (notebook 3)
111 Children's Cardiomyopathy Foundation, www.childrenscardiomyopathy.org accessed April 14, 2005. (notebook 3)
119 SADS Foundation, 2005
120 Dominico Corrado et. al., "Cardiovascular Pre-Participation Screening of Young Competitive Athletes for Prevention of Sudden Death: Proposal for a Common European Protocol," European Heart Journal, (2005) 26, 516-524, Feb 2, 2005
121 Lisa Schnirring, "Groups Endorse ECG Screening for Athletes, "The Physician and Sportsmedicine," Vol 33, No. 3, March 2005
122 Barry J. Maron, MD, et. al., "Recommendations for Physical Activity and Recreational Sports Participation for Young Patients with Genetic Cardiovascular Diseases," Circulation, June 8, 2004
123"Long QT Syndrome, An Overview," Sudden Arrhythmia Death Syndromes (SADS) Foundation, 2003
125 Greg Arnold, DC, CSCS, "Experts Strongly Recommend the 12-lead ECG be Used in the Pre-Participation Physicals of Young Athlete", excerpted from European Heart Journal Feb 2, 2005.
129 Laurie Barclay, MD, "Cardiovascular Screening of Young Athletes: A Newsmaker Interview with Antonio Pelliccia", MD Medscape, Feb 4, 2005
133 "Heart Screening for All Young Athletes?" Ivanhoe Newswire, www.ivanhoe.com, Feb 7, 2005
142 Dominico Corrado et.al., "Cardiovascular Pre-Participation Screening of Young Competitive Athletes for Prevention of Sudden Death: Proposal for a Common European Protocol," European Heart Journal (2005) 26, 516-524, Feb 2, 2005