Cardiac surveillance for athletes

DAVID W. UNKLE -- Special to SLAM! Sports

, Last Updated: 7:25 AM ET

PHILADELPHIA -- The collapse of Detroit Red Wings' defenceman, Jiri Fischer in Monday's game against the Nashville Predators, underscores the need for cardiac surveillance beyond basic electrocardiography (EKG) in athletes.

The 25-year-old, Fischer skated six shifts, a total of 4 minutes, 52 seconds in the first period before collapsing on the Red Wings' bench.

Team physician, Dr. Tony Colucci initiated cardiopulmonary resuscitation (CPR) when he was unable to detect Fischer's pulse. Dr. Colluci was quoted on Sports Illustrated.com that "Fischer's heart may have been experiencing ventricular tachycardia or ventricular fibrillation."

According to reports posted on website of WJR 760-AM in Detroit, a structural defect in Fischer's heart may have precipitated the abnormal ventricular heart rhythm.

"(Fischer) has a condition known as apical hypertrophic cardiomyopathy (HCM)," said Dr. William O'Neill, Chief of Cardiology at William Beaumont Hospital and someone familiar with Fischer's condition.

HCM, the most common form of sudden cardiac death (SCD) among athletes, results from an increase in the size of the heart muscle and the heart's lower chambers, or ventricles.

Patients with HCM frequently present initially with ventricular dysrhythmias such as ventricular tachycardia or ventricular fibrillation. Both ventricular dysrhythmias result in a rapid, chaotic, beating of the heart and can produce heart rates exceeding 300 beats per minute.

As a result, the ventricles or the lower part of the heart pumps little to no blood to the body. Sudden cardiac death (SCD) is said to occur when there is no cardiac output or identifiable pulse.

Various studies in the medical literature estimate the incidence of SCD to be 1 to 2 deaths in 200,000 each year. That risk is significantly increased, (as high as 95% in the United States) in the athlete who has a pre-existing cardiac condition.

Fischer was diagnosed with cardiac arrhythmia or abnormal heart rhythm on EKG prior to the 2002-03 NHL season. Dr. Colucci reported that Fischer underwent exercise stress testing at that time and that his heart was "essentially a little thicker than normal."

Fischer's path back to the Red Wings remains unclear.

Medications commonly used to prevent recurrence of ventricular fibrillation and ventricular tachycardia in the general population can create additional problems in athletes.

During peak exercise, the medication designed to prevent arrhythmias, may in fact promote may increase the incidence of arrhythmias, when the body's release of adrenaline is accentuated.

Furthermore, the effects of medications may impair the peak exercise performance and may be poorly tolerated.

The Red Wings announced that Fischer was released from Detroit Receiving Hospital on Wednesday and is resting comfortably at his home.

"It's fantastic that (Fischer) is alive and had no major neurologic damage, but I would think that his career as a hockey player is over," O'Neill told the Detroit radio station.

Fischer was placed on injured reserve by the Red Wings.

Fischer, a first-round selection of the Red Wings in the1998 NHL Entry Draft, appeared in 22 games this season for Detroit, scoring three goals and eight points.

In 305 NHL contests with the Red Wings, Fischer has 11 goals and 49 assists.

The Red Wings ask that fans wishing to show support for Fischer consider making a donation to the Children's Hospital of Michigan Wish Club (313) 745-5024, a charity that Fischer was involved with over the last five years.


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