Q: Recently, two young athletes died from sudden cardiac death. Can you explain what caused their heart condition? Why can’t sports teams screen their prospective athletes to prevent it? — B.R., Orlando
A: The recent deaths of Chicago Bears defensive end Gaines Adams at age 26 and Southern Illinois basketball center Jeron Lewis, 21, presumably from sudden cardiac death, underscore the importance of identifying this potentially deadly medical condition during a player’s pre-participation medical evaluation.
Sudden cardiac death results from a lethal heart arrhythmia induced by abnormal thickening of heart muscle. This disorder of heart muscle cells is called hypertrophic cardiomyopathy, or HCM, and is due to a genetic mutation. It’s estimated to affect one in every 500 Americans; however, 50 percent of those who die from sudden cardiac death are African-Americans.
Although there are medical and surgical treatments for HCM that can greatly reduce the chance of dying from sudden cardiac death, the key to preventing unnecessary death is to identify those who have probable HCM in elementary, middle or high school through pre-participation screening exams and electrocardiograms. A heart murmur should prompt an echocardiogram (ultrasound of the heart). Although a screening physical may only identify a small percentage of those with HCM (since most have no symptoms), the addition of a routine EKG can identify 50 percent to 80 percent of those at risk for sudden cardiac death. For college and professional athletes, the addition of an echocardiogram can identify if an athlete has an enlarged heart, valvular abnormality or a thickening of the heart wall (the classic finding for HCM).
Q: What is urine microalbumin? My doctor ordered the test as part of my recent physical. It showed an abnormally high reading and now my doctor wants to put me on blood pressure medication even though I don’t have high blood pressure. Does that make sense to you? — K.L., Huntsville, Ala.
A: Albumin is protein. Microalbumin is an amount of protein that’s too small to be detected as part of a typical “dipstick” urinalysis. Persistent protein in the urine is bad, even in small amounts. The kidneys, which filter our blood, are not supposed to allow protein to pass through. If protein is passing through on a steady basis, there must be some sort of kidney damage, slight as it might be. Being able to detect microscopic amounts of albumin allows us to catch a kidney problem at a very early stage.
It’s important to check a microalbumin level in all diabetics at least once a year. The presence of an increased amount of microalbumin in the urine is associated with a higher risk of heart disease and related death. It’s also a harbinger of frank protein in the urine seen on a dipstick urinalysis.
Lowering blood pressure has been shown in several studies to reduce the progression of protein in the urine — even if you don’t have high blood pressure.
Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: “Ask Dr. H,” P.O. Box 767787, Roswell, GA 30076. Because of the large volume of mail received, personal replies are not possible.