A heads-up on hearts

                                                                 Lee Wedlake

One of my senior instructors has a brown belt with a pacemaker and defibrillator. The student has an enlarged heart and has since he was a child. His belt tests and regular classes have to be monitored and he has the sense to step out when he's feeling over-exerted. It's the enlarged heart that is sometimes not detected in athletes until after they have some sort of episode or drop dead.

            Once again, I urge school owners and instructors to get a basic medical history from incoming students. Find out what medical problems they know of so you can adjust accordingly. It may be something you are not willing to accept in a student and won't take them in. It's all in the interest of safety.

            All this said, below you'll find an e-mail between myself and a physician student of mine referencing the aforementioned brown belt. It may be of interest to you if you have a student with a similar condition or taking the same medication.

Lee- here is a link that includes recommendations that are well accepted for competitive sports but specifically reference activities that may result in bodily trauma. I include their special considerations below. Once these statements are published in respected refereed journals people who choose to not follow their recommendations are place in a legally awkward position. Marc

http://content.onlinejacc.org/cgi/content/full/45/8/1318
 the 36th Bethesda Conference report is presented here in the context of measured and prudent recommendations—intended neither to be overly permissive nor restrictive—and which should not be regarded as an absolutely rigid dictum. Indeed, the managing physician with particular knowledge regarding a given athlete's cardiovascular abnormality, psychological response to competition, and other medically relevant factors may choose to adopt somewhat different recommendations in selected individuals.
       Special considerations
Three considerations relevant to much of the document deserve special consideration. First, medications, such as beta-blockers commonly used to treat a variety of cardiac diseases including systemic hypertension, HCM, long QT syndrome, and Marfan syndrome, are likely to inhibit performance in trained competitive athletes (7). The use of such drugs in athletes cannot be regarded as either a means of affording safety and specific protection against arrhythmias, nor as a primary means for retaining eligibility in vigorous competitive sports. Furthermore, use of beta-blockers is specifically contraindicated in some sports.

Second, the availability of a free-standing automatic external defibrillator at a sporting event should not be considered either as absolute protection against a sudden death event, a prospectively designed treatment strategy for athletes with known cardiovascular disease, or justification for participation in competitive sports that otherwise would be restricted owing to underlying cardiac abnormalities and the risk of life-threatening ventricular tachyarrhythmias.

Third, with the increased employment of the implantable cardioverter-defibrillator (ICD) it is inevitable that increasing numbers of high-risk athletes with defibrillators will come to recognition. Although differences of opinion exist and little direct evidence is available, the panel asserts that the presence of an ICD (whether for primary or secondary prevention of sudden death) should disqualify athletes from most competitive sports (with the exception of low-intensity, class IA), including those that potentially involve bodily trauma. The presence of an implantable device in high-risk patients with cardiovascular disease should not be regarded as protective therapy and therefore a justification for permitting participation in competitive sports that would otherwise be restricted. This conservative but prudent posture is justified on the basis of the uncertainties associated with ICDs during intense competitive sports, including the possibility that the device will not perform effectively at peak exercise, the likelihood of a sinus tachycardia-triggered inappropriate shock or an appropriate discharge, and the risk for physical injury to the athlete or other competitors as the result of an ICD shock. Also, pacemaker-dependent athletes should not participate in most competitive sports that potentially involve bodily trauma.