South Florida experts say parents of young athletes need to ask more questions about medical safety after the traumatic incident Monday night involving Buffalo Bills star Damar Hamlin.
Hamlin went into cardiac arrest after a tackle during an NFL game Monday night, leading medical experts to speculate the cause could be a condition known as commotio cordis. The 24-year-old safety remains in critical condition at University of Cincinnati Medical Center after he collapsed on the football field minutes after a tackle.
While rare, commotio cordis is triggered by blunt trauma to the chest and causes the heart to enter an arrhythmia when the hit to the chest happens at the exact right time in the cardiac cycle.
“Once that happens, it is difficult to get someone out of it,” said Dr. Leonard Pianko, an Aventura cardiologist. “The longer it goes on, the more damage that can take place.”
Commotio cordis is seen mostly in young athletes between ages 8 and 18 who play sports with projectiles such as baseballs, hockey pucks and lacrosse balls, according to the University of Connecticut’s Korey Stringer Institute. Reported cases remain relatively infrequent, less than 30 per year. There have only been 200 cases of commotio cordis reported since 1995.
The anatomical differences in the chest wall thickness of young people may play a role, medical experts say.
Hamlin received CPR on the field for roughly 10 minutes before being taken to the hospital. Medical experts say parents need to give more scrutiny to safety measures when their children play sports
“The bigger question for parents is, ‘where my kid participates if something happens, are there medical personnel there?’” said Dr. Lee Kaplan, director of the University of Miami Sports Medicine Institute. “Are there athletic trainers who are life support (CPR) certified? Is there a defibrillator nearby and someone who knows how to use it?”
Time is of the essence when a cardiac event occurs on an athletic field.
“Once you pass five minutes, the likelihood of brain damage increases,” said University of Miami cardiologist Dr. Rober Myerburg.
EMTs aren’t required at all high school athletic events, but they are present at some, especially football games
While speculation on Hamlin’s condition centers on commotio cordis, Myerburg, a UM professor who treats many athletes, said other heart conditions are equally if not more likely. “I saw the video, and the nature of that hit is not the type that causes cardiac arrest. He could have structural heart disease or a genetic abnormality, or it could be unusual commotio cordis. We won’t know until they are done doing a workup.”
The most common cause of cardiac arrest in athletes is hypertrophic cardiomyopathy, a disease of the heart, with abnormal thickening of the heart muscle. It is associated with sudden death in younger athletes.
More teams at all levels of the sport now require athletes to undergo pre-participation physicals to catch those at risk for cardiac abnormalities. But not all teams require an EKG, which Myerburg and other experts believe would prevent some cardiac events in athletes.
“I have been recommending pre-participation EKGs to all athletes,” he said. “It’s not a perfect test but at least it would find things that are identifiable.”
But EKGs can be costly, which has been an impediment, said Dr. Geden Franck, primary care sports medicine specialist with Memorial Sports Medicine Center. “Some conferences require it. Some don’t.”
Sports injuries are part of the game, but protocols to increase safety are helping, said Franck, who is the team physician for Florida Memorial University, University of Fort Lauderdale and Florida National University.
He advises athletes to do as much as they can to learn their medical risks.
“Make sure before any activity like football or baseball, you talk to your physician, do your physical, and make sure every area of your medical history, background and risk factors are discussed,” he said. “Prevention is key to decreasing these rates of cardiac events and being alert to players who need further intervention.”
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.
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