Original link: http://www.metrowestdailynews.com/homepage/x1544179199

Sudden deaths among teens a rarity

By Peter Reuell/Daily News Staff

The sudden death of two seemingly healthy, teenage athletes during practice in recent weeks may point to undetected heart problems, MetroWest and Milford-area doctors said yesterday.

Although rare, such unexplained deaths in teens are most often the result of a handful of conditions that may never be detected until after death, doctors said.

"Often times, especially in young adults, their first symptom can be sudden death," said Margot Putukian, director of Athletic Medicine at Princeton University, who has studied the phenomenon.

On Saturday, 15-year-old Nicholas Souza of Medway collapsed following a series of conditioning drills during lacrosse practice. He was pronounced dead less than an hour later.

Souza's death came less than a week after William Judge, 14, died during a non-contact lacrosse practice drill at St. Sebastian's School in Needham.

Despite the pair of recent incidents, Lars Erickson, a consulting pediatric cardiologist at MetroWest Medical Center in Framingham, said such incidents are "extremely rare."

"We used to think it was about one in 500,000," he said. "More recently, it seems like it's about one in 200,000, but it's still very rare.

"I discuss this with families very frequently, because it does tend to be something that looms large in people's level of concern."

About half of the cases that do happen, Erickson said, can be traced to conditions like thickening of the heart muscle, abnormal heart rhythms or structural abnormalities like tight heart valves and tight arteries.

The problem, said William Shine, a consulting cardiologist at Milford Regional Medical Center and UMass Memorial Medical Center in Worcester, is "the ability to detect these problems is extraordinarily poor."

There are, however, signs to watch for.

"What kids need is a real thorough personal family history," Shine said. "Is there a family history of sudden death, or a history of someone dying in the family of an unknown reason? Those are always concerning stories to a cardiologist."

Another item to watch for, he said, is how teens handle exercise. If they pass out, have chest pains or shortness of breath, it could point to a more serious problem.

"Passing out during athletics is a very dangerous thing until proven otherwise," he said. "Most cardiologists would say you're not allowed to work out again until we do a full workup."

Such steps, combined with a thorough physical, Shine said, can catch many dangers early on.

Other tests, though, are more controversial.

While some guidelines call for all athletes to have an EKG test before participating in athletics, some say the tests can be misleading.

While the test would certainly pick up those with heart problems, experts say they would also pick up dozens, if not hundreds, of false positives.

"If you do that, you're going to get a lot of kids who will have slightly abnormal (readings)," Putukian said. "As a team physician, the part that's frustrating is you'd like to think you could screen for and pick up these things, and unfortunately it's really not that easy."

Simply by virtue of their training, she said, many athletes will have EKG readings which appear to show trouble. Trying to clear every such athlete for competition, she said, would quickly become prohibitive.

That's not to say athletes or parents should ignore warning signs.

"If there are symptoms, take them seriously," Putukian said. "That's the most important thing, but you can't screen for everything."

"What I think parents should know is two things," Erickson said. "They should know what the recognized warning signs are - fainting and family history.

"Second, they should understand, even with the increased incidents we're seeing, it's only one in 200,000."

(Peter Reuell can be reached at 508-626-4428, or at preuell@cnc.com.)