 In the studio for this week's Your Health are Dr. Jeffrey Rosenthal, pediatric cardiologist from the University of Maryland Children's Hospital, and Dr. Scott Jerome. He is a cardiologist with the University of Maryland Medical Center. Gentlemen, thank you so much for coming in, and I appreciate you bringing props because that always helps. Thank you. And we're going to address that in a second. But I want to first start off by talking about the fact that you are partnering with the University of Maryland College Park to sort of screen all active student athletes. Can you tell me a little bit more about why that's happening and how long it's been going on for? So the screening process for college athletes has involved sports medicine doctors, orthopedists, athletic trainers, and others. And in the last few years, the athletic department at Maryland, and actually throughout the university system, the athletic departments have wanted to increase the screening for cardiovascular risk factors. So we are increasingly involved as part of our larger team that's trying to create a context where athletes can participate safely. We hear a lot about major injuries to the body, right, for athletes, torn ACLs, minor sprains, hamstrings, the whole nine. But we don't really hear a lot when it comes to heart issues or heart defects. Is it just that sports cardiology is something relatively new, or what are the reasons why we're starting to hear, pay more attention and more focus on heart issues? Heart issues have always been around, and you've always heard of basketball player collapses and drops dead, even back into the 70s and 60s, and it always makes big news, a young... It's the case, yep. Yep. All of a sudden it makes big news, and it's a person who's supposed to be at the peak of their health, and how do they die? What happened to them? So many times it's asymptomatic until a certain event happens, something bad. Our job is to try to find out who's at risk ahead of time and prevent that from happening, whatever sport they're playing in. What does a sports cardiologist do that sort of maybe differs from a regular cardiologist in terms of its screenings, or what is it in particular? Yep. So the usual pre-participation screening for athletes in the United States involves taking a detailed history, both for the athlete and for the athlete's family to understand the health history, and then a physical exam. And in the sports cardiology domain, for athletes where there's any concern at all based on that initial screen, we do further testing. So we may do EKG testing, echocardiography, which is ultrasound testing of the heart, exercise testing, long-term monitoring of heart rhythms. So the sports cardiologist really comes in when the initial screen has indicated that there might be a problem, so that we can approach athletes and keep them safe. Scott, can you tell me a little bit more about these props that you brought in? What exactly am I looking at here? This is actually a heart, and there's two sides to the heart. There's a right side and a left side, and both are affected by athletics. Depending on what kind of sport you're doing, it changes the heart size and changes the heart function. So what's normal in a non-athlete all of a sudden may look abnormal, and boy, maybe that's an athletic heart versus a normal heart. So this is kind of what a heart looks like. And what kind of a difference is it in terms of the sport that you're doing, whether it's more a weight-bearing sport or an endurance sport, like training for a marathon? So an endurance sport like a marathon causes this chamber, the left side, to dilate, just get bigger, as well as the walls get thicker. Wear a weight-lifter. Somebody uses a lot of strength. It doesn't really dilate, but the wall thicknesses get much thicker. So if you look at that heart, when a normal person, you'd say, Boy, we're looking at a graphic now, right? Yeah. So you can see the difference between the endurance athlete and the strength athlete and how the heart's size, how it dilates, how the wall is thickened. In a normal person, that could be really bad and dangerous, and you've got to figure out whether it's an athletic heart or whether it's a normal heart. That's a good segue to my next question of, how would you define an athlete, and why is that definition of athlete so important when it comes to heart health or even heart-related risks? Well, I mean, we actually use the common definition of athlete. So it's someone who participates in athletic activities for either recreational reasons or for more competitive reasons. There are between seven and eight million high school athletes in the country and about half a million athletes who participate in NCAA sports. And then there are others, like Dr. Jerome and myself, who are weekend athletes or... Weekend warriors, kind of. Exactly, exactly. And in some ways, the people who fall into that group are the ones who really may need sports cardiologists. Often, the risk is much higher among people who think they're healthy and are going out to just exercise on the weekend. But how do you know? I guess one of the things is, and you deal with pediatrics, so is there any way to tell if there's any defects that are present from birth that you could maybe prevent from happening later on, unless, I guess, screening testing? Is that the only way? I can address that. So about around 1% of all live-born newborns have some form of congenital heart disease. So around 1% of kids are born with some form. And of those, well, actually what's happened is that people with congenital heart disease are living longer and longer. So now there are actually more adults with congenital heart disease than there are children. Some forms of congenital heart disease are such that participation in different kinds of athletic activities would be dangerous. So part of the screening involves trying to identify which student athletes may have forms of congenital heart disease that would put them at risk. What are the other pressures that athletes may face that could cause any kind of cardiac problems or any issues that could arise? Well, the pressure is to play. Some of these kids are scholarship athletes. They're worth a lot of money. They may be headed to pro-sports. And how much is their health versus wanting to play? There's actually now a barrier between the doctor and the coach. So we don't get any pressure from anybody. We just make medical decisions. What do you say to a student athlete who you do detect that there's a cardiac problem and that they're right in their prime or they're doing really well in high school about, I mean, how do you buffer that information or do you not? Well, you know, we approach them with a sensitivity that sports are an important part of their lives. But our primary concern is their long-term health. So we approach that. We try to understand what their risk is with different athletic activities. And then we work with them as physicians to try to mitigate their risk. Dr. Jerome, since we've got this other prop here, is there anything that you can tell me a little bit more about this? We're looking obviously at a heart again. Anything we need to know in particular? Well, you know, we have the heart in the middle. We've got the lungs. And of interest, there's the aorta in the back. And you notice a lot of these basketball players are seven feet tall and things like that. Sometimes that's a genetic problem that can actually weaken that aorta, this big tube. And sometimes it can rupture. And that's one of the things that we look out for. An aortic dissective tear, perhaps? Exactly, or a disease called Marfan syndrome. And he's very tall people. And in some of those instances, if you don't catch that in time, that's pretty fatal. Am I wrong about that? It can be. If it's not detected, it can be. And I have to say that the sports medicine doctors, not just sports cardiologists, but the sports medicine doctors work as a team, these doctors are very good at identifying not just cardiovascular risks, but other risks to athletes. So this is a team sport. Caring for athletes is a team sport. And the University of Maryland has invested a lot in the care of its athletes. If an older person wants to start exercising, what are some of the heart-healthy ways to do it? Well, as the athlete gets older, the common things start. They have risks for high cholesterol or high blood pressure, and they think they're healthy. And if you think about heart attacks, most heart attacks, they were fine one day. Next day, they had their heart attack and died. So someone says, oh, I'm going to start doing a training for this 10K or a marathon race. So we want to kind of look at these patients in a different light. They're just not going to go out and walk. They're going to start doing some heavy-duty activity. So they want to start off really slow, and they want to be screened ahead of time to make sure they don't have underlying heart disease that we don't know about. You know, also, we ask adults and other athletes about whether they have any symptoms with exercise. Are they experiencing chest pain with exercise? A change in their ability to exercise? Have they ever fainted? These are all important questions that help to create some focus around what we should be screening for. Speaking of screening, what would you recommend people say to their doctors? Do they say, I need to see a cardiologist? I'm doing some endurance training. I mean, how do you even broach the conversation into whom in terms of testing and screening? It was interesting. I had a patient that just popped up and said, I want to do 100-mile race. And I said, wow. So that's a lot of endurance. And he went to his regular doctor and said, 100 miles, that's a huge amount of running. You need to see a sports cardiologist for that. So that's how he popped up. It depends on how much activity they're actually doing. But somebody who's starting from zero, they really need to gradually get into this. You've got about 30 seconds left. What's some last-minute advice you'd like to give to student athletes to help them be more preventative in their care when it comes to heart issues? I think the biggest issue is to just be honest. If they're experiencing symptoms to speak with their trainer, with the physical therapy team, or with their coaches and other docs. Wonderful. Gentlemen, thank you very much. We appreciate that. Thanks so much. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.