Social Pressures

What is HCM?

Did you know:

54% of athletes said they have played injured

Why? I was needed and couldnt let the team down. I didnt want to be benched. It
was an important game.
13% felt as if they couldnt let the team down
12% didnt 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 dont do anything to prevent injury
HCM causes 36% of all sudden deaths in US competitive athletes
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 gradually 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.

OVERVIEW

Science Behind It . . . . Page 2

Hypertrophic Cardiomyopathy (HCM) is a genetic heart
disease that is the leading
cause of sudden cardiac arrest in athletes. An estimated 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 information on the historical,
scientific, economic and social aspects of the disease.

Eugene Braunwald

Marc-Vivien Foe
June 6, 2003

Sergejs Zoltoks
November 3, 2004

Jason Collier
October 15, 2005

Economic Issues . . . . .Page 3

Social Pressure . . . . . . Page 4

The History of HCM

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 contractions. 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.

Notable Cases of HCM

Reggie Lewis
July 27,1993

History of HCM . . . . . Page 1

Eugene Braunwald is considered by many to be the

father of HCM. His discoveries were crucial to the
understanding and treatment of the disease. Without him, many people with
heart problems would remain misdiagnosed today.

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 another operating room. Dr. Morrow had just arrested,
or stopped, a different patients heart and found that
there was no obstruction in the LVOT. Dr. Braunwald
was confused, and he didnt know what could have
caused this heart problem. Soon later, another patient with identical symptoms appeared. Dr. Braunwald 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 hypothesized the cause of the heart disease. They believed 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 increased 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.

From the doctors.

In nearly 80% of all cases of HCM, the patients are Asymptomatic.
-Mike Elliott M.D.
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 deadly 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.

Economic Impacts
Costs for HCM first start with diagnosis. There are many methods for diagnosis: CT scans, echocardiograms,
and even MRIs. The most common
of these is the echocardiogram. This
technique for diagnosis costs anywhere from $1,000 to $2,000. This is
a costly test and it cannot even independently determine whether someone has HCM or not.
If diagnosed with HCM, the cost can
become much greater. One extremely promising treatment for
HCM is Ventricular Septal Myectomy.
This procedure costs around
$41,715. However, most patients
see vast improvements after this surgery. The surgery will improve

their everyday life and significantly

reduce their chances for sudden cardiac arrest.
There are other ways to treat HCM,
but none are as effective or as expensive as the Ventricular Septal Myectomy. One other treatment is the
implantation of an Implantable Cardioverter 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 Calcium Channel Blockers. These can cost
between $300 and $400 per year.
Although these treatment costs can
add up, most are covered by insurance.

SOCIAL MEDIA
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SOURCES OF RESEARCH
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
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.

"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.