“I had no trauma, no pain, no warning. My head just dropped,” Gale recalls of that Thursday in September 2010. “But I had good timing on my side — and a lot of luck.”
Today, UHealth cardiologists are hoping to put more than luck on the side of high-intensity recreational athletes like Gale, as well as competitive athletes and others embarking on new exercise programs, by establishing a monthly clinic at University of Miami Hospital focused on hypertrophic cardiomyopathy and other inherited and acquired causes of life-threatening heart rhythm disturbances.
The clinic is aimed at detecting and reducing the risks of sudden cardiac death through screenings, physical evaluations, family histories and genetic testing for inherited syndromes like hypertrophic cardiomyopathy. The most common cause of sudden cardiac death among competitive athletes in the United States, hypertrophic cardiomyopathy occurs when the heart walls are thicker or larger than normal, causing arrhythmias, restricted blood flow, or certain forms of heart failure. Among middle-aged and older recreational athletes, the most common cause is unrecognized coronary artery disease that begins in the early to mid-30s. However, less common and rare disorders should not be overlooked even up to the early 50s, as many of them express most commonly in the 30- to 45-year age range.
As was the case with Gale, who seemed the picture of good health until his collapse from clogged arteries that produced only painless ischemia, about one-half of the 300,000 Americans who die from sudden cardiac arrest every year exhibit no prior warning signs.
“Fifty percent of cardiac arrests are first events. In other words, the patient has no forewarning and death is the presenting event of underlying disease,” said Robert J. Myerburg, M.D., professor of medicine and physiology, the American Heart Association Chair in Cardiovascular Research, and a national authority on sudden cardiac death. “A recent study also showed that the number of sudden deaths that occur in recreational athletes is far more than competitive athletes, not because they are at any higher risk, but because there are so many more of them. Yet our screening strategies tend to focus on competitive athletes. The recreational athlete really needs greater attention.”
Myerburg directs the interdisciplinary clinic, which includes Cardiovascular Division faculty in the fields of electrophysiology, interventional cardiology, and imaging, as well as faculty from the Hussman Institute for Human Genomics.
He can’t say whether an evaluation could have averted Gale’s sudden heart disturbance, nor the stent, triple bypass surgery and implanted defibrillator that eventually put him back on his feet and his bike. But a review of Gale’s family history almost certainly would have raised a red flag, perhaps leading to a stress test that would have revealed the deadly blockages. Not only does high cholesterol run in Gale’s family, but both his father and grandfather died very suddenly at young ages – in their 40s and 50s – from apparent cardiac arrest.
“One of the most important things to understand is that sudden cardiac arrest tends to cluster in families, so if there is a strong family history of sudden cardiac arrest, especially as the first manifestation of disease, we have to pay particular attention,” Myerburg said. “When just one side of the family is involved, the chances of the first event being cardiac arrest are about twice what it would be without that family history. If both sides are affected, there’s a nine times greater risk.”
Located in Suite A on the second floor of University of Miami Hospital, the clinic is open the first Friday of each month, providing baseline EKGs or echocardiograms to patients whose symptoms, evaluations or family histories raise red flags and, in collaboration with the Hussman Institute, genetic testing and counseling for inherited conditions like hypertrophic cardiomyopathy.
“The goal of the Cardiovascular Division is to establish a Hypertrophic Cardiomyopathy Center that links with a group of such centers nationally,” said Mauro Moscucci, M.D., M.B.A., Chief of the Cardiovascular Division and Interim Chair of Medicine. “The broader focus on other inherited and acquired disorders among athletes is being developed in parallel in the same clinic. As the program grows, we anticipate adding more clinic sessions.”
Myerburg also hopes that, one day soon, researchers will find genetic markers that help identify people with common diseases like coronary artery disease who, like Gale, are at risk for sudden cardiac death as the first manifestation of the disorder.
In the meantime, Gale, who is preparing for a 200K ride from Vero Beach to Jupiter and back this month, continues to undergo periodic stress tests to monitor his heart health – and to show his gratitude for that anonymous nurse and his cadre of UHealth specialists for saving his life by raising money for the Miller School’s Cardiovascular Division through the annual “Ride with Heart” cycling event a friend established after his near death.
“He was very lucky to be sitting in that restaurant near that nurse,” Myerburg said. “Had he been biking in Mount Dora, I don’t think he’d be with us today.”
For more information about the clinic, contact Tiana Blount, M.H.A., Practice Director for the Outpatient Cardiovascular & Multidisciplinary Clinic, at firstname.lastname@example.org or 305-243-1900.