New Guidelines on Frequent Cause of Sudden Death in Athletes

Recommendations Aim to Improve the Diagnosis and Treatment of Hypertrophic Cardiomyopathy

Nov. 8, 2011 -- When an athlete dies suddenly on the court or playing field, often an undiagnosed heart condition called hypertrophic cardiomyopathy is the cause.

Now new guidelines aim to shine a light on the diagnosis and treatment of hypertrophic cardiomyopathy (HCM), a disorder that affects an estimated 600,000 Americans.

"It is an important cause of sudden cardiac death during competitive sport, and from that standpoint perhaps is brought to the headlines more frequently,"says Bernard J. Gersh, MD, PhD, who co-chaired the committee that wrote the new guidelines.

"It’s one of the commonest inherited cardiac diseases, and it probably hasn’t had the attention it’s deserved. I think if you talk to people out there there’s a great deal of confusion about how to treat this condition," says Gersh, who is a professor of medicine at the Mayo Clinic in Rochester, Minn.

In HCM, the muscular walls of the heart thicken abnormally, making it harder for the lower chambers to fill and pump blood.

Misaligned muscle fibers can also cause electrical abnormalities that can cause heart rhythm problems.

"Those electrical abnormalities can cause someone to drop dead," says Tara Narula, MD, a cardiologist at Lenox Hill Hospital in New York City.

Symptoms of the condition may include chest pain, shortness of breath, fainting and dizziness during exercise, heart palpitations, high blood pressure, and rarely, heart failure.

In many cases, though, there may be no warning signs, and the condition is discovered during an autopsy.

Doctors want people to know that having HCM isn’t a death sentence. In fact, most people with the condition will have a normal life span.

"This disease, once, not that long ago, regarded as mysterious and almost universally associated with poor outcomes is now a highly treatable genetic heart disease,” says Barry Maron, MD, director of the Hypertrophic Cardiomyopathy Center at the Minneapolis Heart Institute Foundation. Maron co-chaired the committee that developed the recommendations.

The guidelines are jointly published by the American Heart Association and the American College of Cardiology Foundation. They are published in the journal Circulation.

Among the key recommendations:

Although people with hypertrophic cardiomyopathy should not participate in intense or competitive sports, low-intensity aerobic activities like golf or hiking can be a reasonable part of a healthy lifestyle.Because HCM is often inherited, all first-degree relatives of someone known to have the disorder should be screened.Children of parents with HCM should continue to be tested every 12 to 18 months since the disease may only present itself later in life.Patients should be offered genetic testing and counseling.All patients with hypertrophic cardiomyopathy should be evaluated for the risk of sudden death.Patients judged to be at high risk should be offered implantable defibrillators to prevent sudden death.Drug therapy can help control symptoms like shortness of breath and chest pain.Cardiac magnetic resonance imaging can be used to diagnose HCM when electrical tests and ultrasounds are inconclusive.When symptoms are severe and not helped by medications, surgeries to remove muscle from the heart wall can help.These surgeries should be performed by doctors who have performed at least 20 similar procedures or at a center dedicated to the treatment of HCM.

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Fault Lines - The Root Cause Analysis Of The Global Economic Quake

Fault Lines, in geological terms, are the fractures in the earth's crust which are a result of a significant displacement of the earth mass - a movement on these lines usually results in massive earthquakes. These fault lines have been summarily been equated with the existence thin fissures and undercurrents in the financial world which have resulted in a tectonic shifts in the way business gets conducted worldwide.

Raghuraman G. Rajan is a Professor of Finance with the University Of Chicago Booth School Of Business and had also served as a chief economist at the IMF. In his book "Fault Lines", he brings apt comparisons with the geological lines which caused much upheaval in the financial status of America and why the world gets affected by it. These are the Financial or Economic Fault Lines which caused the global financial crisis. In fact, Rajan was one of the few economists who had actually warned us about these mild tremors much before the larger financial quake hit all of us.

While the world is struggling to come out of the crisis, blames fall upon few irrational people who caused this meltdown to happen due to the huge risks they undertook leaving a global recession in its wake. Rajan tries to look beyond these few people who supposedly caused the crisis, to those economic policies which were the actual root cause of the problem - and they still persist. He points out that unless those are looked into we continue to sit on a financial volcano which is causing fissures in the global economic crust the shift of which will cause an even massive crisis!

The book focuses on the facts that caused the recent predicament.He basically points out that the crisis was a collective problem caused by a large number of individuals (officials of FIs, governments, politicians, regulators, and even ordinary citizens) who in their own manner were acting as per the flawed economic policies laid out. He mentions that the risk that these policies posed, were not aligned to the benefits one used to draw out of them. He goes deeper into the system to visit those fissures that threaten the economics of the world business order which is heavily dependent on the financial stability of the US.

The American wage structure took a beating and saw the wages getting stagnated between 2002 -2005. These led to making housing credits available easily for the citizens, raising the purchasing power parity and expectations while deepening the Fault Lines in an already fissured economic status - stagnant wages, lesser jobs, inequality in education and health policies etc. Fault Lines points at the deepening pressure on the US to bring the house in order. There are serious inequalities in education, health care, home owning laws - all of which give access to cheap and easy credits - and these policies (touching upon Fannie and Freddie Mae) need to be revisited to ensure more stability in the world economy. The ever widening gap between the rich and poor will continue to put pressure on the government to push easy credit into the market. Rajan tries to expose this system which does not offer a blanket social safety net over one and all; however,

difficult decisions need to be taken to look beyond the short term incentives the policies have to offer. Change policies to make the economy robust and stable for a longer period of time. In all Fault Lines is a serious and essentially thoughtful book.

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