 A show about universal topics with a Latina point of view. Stay smart. Today on Latina Voices Smart Talk, a needed discussion about sudden death among young athletes. Why are so many young people dying suddenly while playing sports? We'll have some questions and answers. Hello everyone, I'm Inera Perez. Welcome to Latina Voices Smart Talk, a show about universal topics from a Latina perspective. Dr. Paulo Angelini is the medical director at the Center for Coronary Artery Anomalies at the Texas Heart Institute. He's a pioneer in this area and played a major role in a screening program that hopes to reach 10,000 young athletes before they hit the fields or basketball courts. Undiagnosed, hyperthropic cardiomyopathy is the leading cause of sudden cardiac arrest in children, especially young athletes. It is estimated that approximately one out of 100 children have an undiagnosed heart condition. Today, Dr. Angelini will help share how he hopes early detection of predisposing factors could possibly save thousands of young lives. Dr. Welcome to Latina Voices. We welcome you. Absolutely. And let's just set the tone here. There have been an inordinate number of cases lately, more so than any other time that I can remember, where there are so many young people just dropping dead on the field. What is happening? Well, in part is real, in part is the perception, in part is what you report in the media, in part is the real problem of existence of this tremendous tragedies that continue to repeat. And unfortunately, until now, we have been stuck to a reactionary type of position where we react with emotional reaction and not with a plan. And in the last three or four years, we started the Texas Heart Institute, a center that wants to face directly and scientifically this issue of sudden cardiac death in the young in general. And try to come up with a more mature science behind the reason for this event and the best and most effective and most affordable ways to prevent the occurrences. Because basically we have on one side the occurrence of tragedies where the mortality on the field for an out-of-hospital death or cardiac arrest is something like 94%. Only 6% will survive a cardiac arrest outside the hospital. And on the other, we have all these events that can be prevented if we're only knowing time because what we are told and we're not totally sure that is correct is that more than 90% of the events are due to conditions that can be identified ahead of time. The paradox of these conditions is that usually the sudden cardiac arrest or sudden cardiac death in the majority, unfortunately, is the first and last manifestation of the condition. As a mother of three, I'd rather my child not be the one out of 100. And I've got an almost eight-year-old that has already said that baseball and football, here we come, and practicing for hours in conditions that you question. That said, what can someone do to see if they could be that one out of 100 unlucky? Yeah, many things can be done. And until now, there is a big discussion in the established science or clinical practice given by guidelines of the American Heart Association, American College of Cardiology, American Society of Sports Medicine that say, well, in the states, only we accept as a routine screening a visit with a general practitioner or a nurse. And that's all the preliminary screening that we do. And with this problem, we catch something like 2%, 3% of the conditions that create the risk. So that is an approach that is acceptable if we assume what is in the press, in the medical literature, too, that this is a rare event that is not worth creating great apprehension and to create a massive fight for. On the other side, in Europe, they claim that there is a much better outlook for prevention if we do just an EKG, which is a minimal electrocardiogram, is an electric, simple, non-invasive test of low cost. And they claim, an Italian group claimed and made history in this field that 90% of the sudden death in athletes can be prevented by instituting an EKG as a routine screening test. We have come to the opinion that actually most of the conditions cannot be identified with the EKG alone, that we need to have a little more precise screening. And if we start with the standard, which is unfortunately the necropsy, the study after death, we see from those statistics that 90% of the cases have indeed a plausible cause of death. And most of these causes can be prevented. They can be prevented with medical treatment or just with upstanding, preventing excessive or aggressive competitive sporting activities. So there are solutions if we just know who is at risk. The perception, though, is that a lot of these athletes are either African-American, they have heart defects to begin with already, and it could be a part of a lifestyle. Is that what you are seeing? Well, we see many things. On one side, a large study unprecedented in medicine of doing 10,000 normal, or perceptive to be normal, kids in middle school. And 10,000 to establish the incidence of factors that we have been told that will lead to sudden career death. On the other side, we do EKG and a brief history. Parallel to this study that is called MRI-based screening, we do a large study of all the autopsies in the forensic center in Newston. It is a huge center that receives something like 3,300 bodies for exam after death. And we found out that there are something like 600 to 800 kids that are called young, 12 to 35 years of age. They come to die of some reason. And of this something like 50, we have found with the initial experience, 50 a year in the Houston area will die of sudden career death in town. That contrast with what is reported in the big literature, mainly coming from Minneapolis, where there is a center that has established most of the science in this field, claiming that 60 to 80 kids every year will die during competitive sports. If you look at the reality of a large population in a situation where most of the sudden death reach a final diagnosis even though too late in the forensic center, you'll find out that only in Houston in 4 million people population community, there are 50 a year that disappear because of something that seems to be related to a heart event. In contrast to the rest of the nation, where does Houston stand or Texas stand? Well, we don't know. We are doing the study exactly to establish firm prevalence of the factors leading to this event and the incidence of this event that will be known only in this sample population initially. That is the way to establish in our mind the affordability. Is it enough, a frequent enough serious as to establish a program to preliminarily screen everybody or only some? But is it true that, and just a quick follow up, is it true that this is also happening in the Army, within the Army that there's special testing going on? We have been involved also with the Army because they have the largest experience exactly of this kind of studies where they know very well a population, especially the recruits, that will stay during two months in a boot camp where they are submitted to a very strict, very aggressive training course. And there, every year, we are told 100 kids die every year. There's still not a, and maybe it's just me, there's still not a concrete answer. What do you tell parents and coaches? What do I tell them to participate to the screen study? As far as probably, are there any symptoms that could have been seen the night before? You know, anything that, because I'm sure that they want some kind of an answer. And I know it's very difficult to give an answer. It's difficult at this time, but this is the reason of doing this study because we want to give answers. We want to say how many times the sudden death event occurs during maximum exercise. The perception that we have now is that only maybe 15, 20 percent are related to exertion. The others are in people carrying the high risk conditions, but it's addressed for doing normal activities. So it's not so dramatically clear if or not athletic activities, competitive activities are the conditions. Fortunately, unfortunately, that is the reason why these cases come to the general knowledge. We have lots of questions. We have lots of questions and you still have a lot of questions as well. You're looking for answers. And we thank you so much for taking the time to come and educate us on all of this, because it's happening so often now that it's scary for any parent to watch this on the news or whatever. And that's what we're learning about this. And it is important to have the context, because otherwise it's terrorism. Yeah, right. Thank you so much for being with us. Thank you very much. Have a great day.