OP ED REGARDING SUDDEN DEATH IN ATHLETES: THE DRAMATIC CASE OF FOOTBALL PLAYER DAMAR HAMLIN
Richard Allen Williams, MD, FACC, FAHA, FACP
Founder, Association of Black Cardiologists (ABC)
President and CEO, The Minority Health Institute, Inc.
Clinical Professor of Medicine, David Geffen School of Medicine at UCLA
Just a few days ago, along with millions of others watching a football game on TV between the Cincinnati Bengals and the Buffalo Bills, I witnessed a young athlete fall to the ground from some type of injury that resulted in what we cardiologists call cardiac arrest, which means that he had suffered sudden death. As the scene played out, Damar Hamlin was successfully given cardiopulmonary resuscitation, or CPR, with the use of chest compressions, shocks to the heart with an automated cardiac defibrillator or AED, and oxygen over the course of several minutes by medical personnel. He was transported to a nearby hospital where he is listed in critical condition at the time of this writing. It is speculated that Mr. Hamlin’s cardiac arrest was caused by a blow to the chest when he tackled an opponent, initiating a cardiac phenomenon called commotio cordis, Latin for “agitation of the heart”, in which the normal heartbeat is disrupted by a lethal arrhythmia. More details of this unfortunate life-threatening incident are forthcoming.
My brief description of this astounding case of a premiere athlete dying on a field of performance understates the real tragedy that underlies this case. About 20 years ago, based on my research, I edited a book called The Athlete and Heart Disease: Diagnosis, Evaluation & Management which describes the various threats to health and life that athletes face every day during their incredible exploits. Despite the fact that it was critically acclaimed, it received little serious consideration. It revealed the fact that there is very little done to determine which athletes are at high risk of sudden cardiac death due to the unknown presence of a cardiovascular defect that renders them unusually vulnerable, such as certain types of congenital heart disease, Marfan Syndrome, and hypertrophic cardiomyopathy as well as atherosclerotic cardiovascular disease. Other than the Bethesda Conferences held annually by the American College of Cardiology to discuss and recommend criteria for involvement of athletes in competitive sports, there has been only modest interest in this area, and little screening is performed. My research also revealed and documented the fact that Black athletes are disproportionately affected by this sudden cardiac death phenomenon, for reasons that are unclear. Worse, little has been done to establish coordinated safety systems and protocols in which emergency personnel, equipment, and education are available at the site of athletic events and in our schools and healthcare institutions.
The tragic sudden death (and hopefully the full recovery) of Damar Hamlin should serve as a cautionary tale and a wakeup call to action; it must be emphasized that we have unconsciously and unintentionally become interested in athletes more for their entertainment value than for them as human beings. That paradigm needs to be reversed. Dr. Mark Jenkins, a brilliant interventional cardiologist in Dallas and a colleague in the Association of Black Cardiologists, suggests that now is the time for us to bring the sports gurus such as the commissioners of the NFL, NBA, MLB, WNBA, NHL, NCAA, AAU, and others together with the various players’ associations and medical associations including the ABC, ACC, American Heart Association (AHA), AMA, and NMA to have a dialogue on these issues. We must protect all of our athletes and we should start doing more now. The timing could not be better, and the urgency could not be greater. Society will be the beneficiary.
Dr. Richard Allen Williams