Social Pressures Did you know: 54% of athletes said they have played injured Why? “I was needed and couldn’t let the team down.” “I didn’t want to be benched.” “It was an important game.” 13% felt as if they couldn’t let the team down 12% didn’t want to be benched 42% of athletes have hidden an injury to continue playing Only 27% of coaches have reported a player hiding an injury 70% of athletes have played injured with a parent or coach knowing about the

injury 53% of Coaches have felt pressure to put an injured athlete back in the game 23% of coaches don’t do anything to prevent injury HCM causes 36% of all sudden deaths in US competitive athletes

Eugene Braunwald

Eugene Braunwald is con-sidered by many to be the father of HCM. His discov-eries were crucial to the understanding and treat-ment of the disease. With-out him, many people with heart problems would re-main misdiagnosed today.

OVERVIEW

Hypertrophic Cardiomyopa-thy (HCM) is a genetic heart disease that is the leading cause of sudden cardiac ar-rest in athletes. An estimat-ed 1:500 people worldwide have HCM. Unfortunately, approximately 1% of HCM patients die suddenly with little to no symptoms. In this flyer, you will find infor-mation on the historical, scientific, economic and so-cial aspects of the disease.

HCM is believed to have first been described in 1869 by a French man named Liouville. He portrayed the disease a condition in which there were contractions in the heart below the aortic valve. However, he never discovered the root cause of these contrac-tions. Later, in 1907, Dr. Schmincke believed that the cause of these heart problems was an obstruction in the left ventricular outflow tract (LVOT). He was correct in that there is something wrong with the LVOT, but there is not an obstruction in it.

People were starting to become closer to the truth of HCM. Unfortunately, it was not until 1958 that someone corrected Dr. Schmincke. In that year, Dr. Eugene Braunwald was operating on a patient when one of his colleagues, Dr. Morrow, called him to an-other operating room. Dr. Morrow had just arrested, or stopped, a different patient’s heart and found that there was no obstruction in the LVOT. Dr. Braunwald was confused, and he didn’t know what could have caused this heart problem. Soon later, another pa-tient with identical symptoms appeared. Dr. Braun-wald and Dr. Morrow set out to determine the root cause of their heart problems.

Dr. Braunwald and Dr. Morrow researched for several months and eventually published a paper that hy-pothesized the cause of the heart disease. They be-lieved that this disease was caused by a hypertrophy of the left ventricle. Simply, they believed that the problem arose from an enlarging of the muscle in a certain area of the heart. They also made several other crucial discoveries about HCM. They found that HCM often ran in families and that the condition was dynamic. This dynamic condition is one in which the only ways to lessen the obstruction are to increase blood pressure or increase the ventricle size. In 1964, Dr. Morrow demonstrated this dynamic attribute by inserting a beta blocker into the heart which in-creased the ventricle size and improved the condition of the patients.

Developments came fairly quickly after this discovery. Echocardiographs were developed to help diagnose HCM and in 1990, the first mutation that helps cause HCM was discovered by Dr. Seidman. Now, scientists know of over a dozen genes that contribute to HCM. All of these developments throughout history were crucial to the understanding of the disease.

The History of HCM

What is HCM?

History of HCM . . . . . Page 1 Science Behind It . . . . Page 2 Economic Issues . . . . .Page 3 Social Pressure . . . . . . Page 4

Hank Gathers lead the nation in scoring and rebounding in the 1988-89 season and was an NBA first round draft pro-

spect. The first signs of Gathers heart issue arose when he suddenly collapsed during a game vs. Cal-Santa Barbara on Dec. 9. On Dec. 14 tests showed a restriction of blood supply to his heart and abnormal rapid heart beats. Later, on Dec. 18 Gathers underwent further tests and was suspected of having high-risk arrhythmias (abnormal rapid heart beats) which could be career ending. Gathers was prescribed to take 200mg of Inderal every twenty four hours, the drugs side effects included fatigue and drowsiness. Yet when Gathers played while on the drug, his performance struggled. Having his NBA dreams in mind, Gathers convinced doctors to gradual-ly lower the dosage to 40mg per day. He also stopped attending appointments where tests would prove if the lowered dosage of Inderal were effective or not. In fact, Gathers was suspected of completely skipping the medication on game days and known to run

wind sprints before games to rid his body of the Inderal. The decision to ignore his condition in pursuit of his career proved to be fatal, as he collapsed on court due to sudden cardiac arrest on March 4, 1990. A later autopsy would reveal that he suffered from Hypertrophic Cardiomyopathy.

Notable Cases of HCM

Reggie Lewis July 27,1993

Marc-Vivien Foe June 6, 2003

Sergejs Zoltoks November 3, 2004

Jason Collier October 15, 2005

From the doctors…. “In nearly 80% of all cases of HCM, the patients are Asymptomatic.”

-Mike Elliott M.D.

Costs for HCM first start with diagno-sis. There are many methods for di-agnosis: CT scans, echocardiograms, and even MRIs. The most common of these is the echocardiogram. This technique for diagnosis costs any-where from $1,000 to $2,000. This is a costly test and it cannot even inde-pendently determine whether some-one has HCM or not.

If diagnosed with HCM, the cost can become much greater. One ex-tremely promising treatment for HCM is Ventricular Septal Myectomy. This procedure costs around $41,715. However, most patients see vast improvements after this sur-gery. The surgery will improve

their everyday life and significantly reduce their chances for sudden car-diac arrest.

There are other ways to treat HCM, but none are as effective or as expen-sive as the Ventricular Septal Myec-tomy. One other treatment is the implantation of an Implantable Cardi-overter Defibrillator (ICD). ICDs use electric signals to help regulate heart rhythms. They cost around $9,000, but insurance covers this cost almost 100% of the time. Another possible treatment for HCM is through Calci-um Channel Blockers. These can cost between $300 and $400 per year. Although these treatment costs can add up, most are covered by insur-ance.

Economic Impacts

SOURCES OF RESEARCH

HCM is characterized by a thickening of the heart muscle and shrinking of the left ventricle. As seen in the picture on the left, the hypertrophied heart on the right has a much smaller space to pump the same volume of blood and therefore exerts too much pressure on the valves. This over-exertion causes heart attacks, which kills many of its victims. There is no cause for HCM, but it is genetic and therefore may display itself within generations of families. With strenuous exercise, patients may feel shortness of breath or chest pain with are the only indicators of this dead-ly disease. We encourage athletes to athletes to notify coaches and parents if they experience any trouble or pain while playing. No game is worth risking your life for. Along with a thickening of heart muscle, HCM causes a disarray of heart cells which alters the pattern of electric signals travelling to it. This alteration causes arrhythmia or irregular heartbeat. A common symptom of arrhythmia is shortness of breath. HCM can be diagnosed in 2 ways. Electrocardiograms (ECG) and Cardiac MRI are the most effective forms in looking for HCM. Electrocardiograms acts as a graph of heartbeat so doctors can look for arrhythmias or an irregularity in the graph to possibly diagnose HCM.

Marian, Ali J. “Hypertrophic Cardiomyopathy: From Genetics to Treatment.” European Journal of Clinical Investigation 40.4 (2010): 360-369. Print.

Neill, Ushma S. “A conversation with Eugene Braunwald.” Journal of Clinical Investigation 123.1 (2013): 1+. Health Reference Center Academic. Web. 18 Feb. 2015.

Ommen, Steve. Personal interview. 16 Feb. 2015

"Hypertrophic Cardiomyopathy - Symptoms, Tests, Treatments." WebMD. WebMD, n.d. Web. 17 Feb. 2015. "Alcohol Injections Safer, Less Costly Than Surgery for Thickened Heart Muscle." Alcohol Injections Safer, Less Costly Than Surgery for Thickened Heart

Muscle. N.p., 5 May 2011. Web. 17 Feb. 2015. Anderson, Brett R., et al. "Electrocardiographic Screening for Hypertrophic Cardiomyopathy and Long QT Syndrome: The Drivers of Cost-Effectiveness

for the Prevention of Sudden Cardiac Death." Pediatric Cardiology 35.2 (2014): 323+. Health Reference Center Academic. Web. 12 Feb. 2015. "Results of Ventricular Septal Myectomy and Hypertrophic Cardiomyopathy (from Nationwide Inpatient Sample [1998-2010])." American Journal of

Cardiology 1 Nov. 2014: 1390+.Health Reference Center Academic. Web. 12 Feb. 2015. Elliott, Michael. “Re: Hypertrophic Cardiomyopathy project.” Message to Jay Natarajan. 16 Feb. 2015. E-mail. “Hypertrophic Cardiomyopathy.” Cleveland Clinic. Cleveland Clinic, 2014. Web. 17 Feb. 2015. http://my.clevelandclinic.org/services/heart/disorders/hcm Fananazapir, Lameh. “Prevalence of Hypertrophic Cardiomyopathy and Limitations of Screening Methods.” American Heart Association (1995): n. page. Web. 19 Feb. 2015. Reiffel, James A., and Jose Dizon. "The Implantable Cardioverter-Defibrillator." Circulation. American Heart Association, 25 Jan. 2002. Web. 10 Mar.

2015. Changing the Culture of Youth Sports (n.d.): n. pag. Johnson & Johnson. Web. 17 Feb. 2015 Eggers, Kerry. "Remembering Hank Gathers." Pamplin Media Group. Portland Tribune, n.d. Web. 18 Feb. 2015.

Maron, Barry J. "Sudden Deaths in Young Competitive Athletes." N.p., n.d. Web.

There are treatments to significantly suppress the symptoms of HCM. Beta blockers such as Inderal can be administered to treat hypertension, angina, and arrhythmias. If the heart is extremely hypertrophied, a Ventricular Septal Myectomy can be performed to alleviate pressure of blood flow into the left ventricle, however this procedure cannot cure HCM because patients are still at risk of arrhythmia and cardiac arrest.

In an interview with Dr. Elliott from Carolinas Medical Center in North Carolina, he mentioned that Cardiac MRI has the power of viewing scarred tissue which could possibly cause cardiac arrest. Since HCM is hereditary, doctors at the AHA experimented with the genetic composition of a human to predict HCM, but they soon realized that HCM was not a mutation in one gene, but rather an amalgamation of mutations in different genes. For this reason, genetic testing is not effective in diagnosing HCM.

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