" "Hypertrophic Obstructive Cardiomyopathy" Stacy Martin, MD
Each year, hypertrophic obstructive cardiomyopathy (HOCM) accounts for 36 to 48% of 10 to 25 cases of sudden cardiac death in athletes under age 30. While 50% of HOCM cases occur spontaneously, 50% appear to be congenital, as mutations in cardiac sarcomere structure can negatively impact the ability of the heart to contract.
With this problem, there's a marked increase in the release of certain growth factors, leading to cardiac hypertrophy, scarring and fibrosis. The problem only gets worse with exercise, as ischemia and arrhythmia lead to further elevated left ventricle pressures and more hypertrophy. Unfortunately, the first symptom may be sudden death, especially since the condition is difficult to detect in patients under age 13. Otherwise, shortness of breath, chest pain, fatigue and fainting are warning signs related to HOCM. If someone (especially an adolescent athlete) has these symptoms, a doctor should consider his or her family history, perform a physical exam, and order one or more laboratory tests (i.e. EKG, echocardiogram).
No cure exists for HOCM, so the doctors typically recommend abstaining from the vast majority of activities — essentially anything that causes transient rises in blood pressure. Surgery has been performed in the most serious cases, but it's not typically recommended due to a 3-5% mortality rate. As a general rule of thumb, if an athlete is in his 30's by the time HOCM is discovered, he's probably going to be okay, and can continue with his normal activity level provided that he doesn't become symptomatic.
No jokes on this one. HOCM is scary stuff. Keep an eye out for these symptoms, especially if you're a young athlete, coach or parent."
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