Medical ignorance claims athletes' lives

A crippling injury or an inevitable death due to an accident is not uncommon in the history of sports. A number of incidents have been reported where athletes or players not only lost their limbs, but also their lives due to various accidents, preventable or non-preventable ailments while engaged in sports both in the local and the international arena. But four consecutive deaths of teenagers in the field of marathon in the recent past is an alarming issue for the authorities and the society.

The gravity of the seemingly coincidental deaths, now believed to have occurred allegedly due to medical negligence has taken a serious twist after ascertaining that all four incidents would have been preventable if a proper method of health test was practised by the authorities prior to the events.

Three schoolgirls and a school leaver, a teenage boy were the four unfortunate victims who died in these isolated marathon races that took place in Chilaw, Moratuwa, Aranayake and Kuliyapitiya in the last two months. They are all believed to have died of sudden cardiac arrests.

The authorities were alarmed when President Mahinda Rajapaksa ordered an immediate inquiry into the matter and to work out a system to subject students selected for sports activities to medical fitness tests prior to the events. The President made the directive in the wake of the third death reported from Aranayake on February 26. Yet, the fourth death was reported a few days ago while the competent authorities were busy formulating a methodology to check the physical fitness levels of the participants.

However, weeks after the first death the authorities have been able to develop a formula to counter the crisis which might eventually put a full stop to similar sports related tragedies in the future.

When contacted by the Sunday Observer, the Director General of the Institute of Sports Medicine Prof. Arjuna de Silva said the Sports Ministry with the Ministry of Health had created a set of guidelines which was sent to all the schools countrywide on Thursday in the form of a circular.

The circular has made it compulsory to conduct a medical test followed by an Electrocardiography (ECG) test on anybody who is about to participate or practise in races above 3,000 metres, including marathon and half marathon.

Referring to the expenses which the athletes have to bear for medical tests Prof. De Silva said the tests and ECG can be carried out free of charge at any government hospital and the parents are strongly advised not to admit their children for races especially if they suffer from any type of ailment or disease. He said many parents and the trainers are satisfied with a simple medical check up prior to the event, but an ECG is a must to ascertain the actual health condition of an athlete.

Another key feature of the circular is to impose an age restriction on the athletes who are to take part in the events.

Expressing his deep concern over the tragedy the professor said that all four deaths were preventable if a simple ECG test had been carried out on each athlete which could help identify their heart conditions and other ailments.

The series of incidents started in Chilaw on January 30 where an Advanced Level student age 19 from Ananda National College collapsed on the roadside while participating in a marathon race organised by her school. The victim, Kaushalya Pavithrani, an arts stream student was found lying on Sedawatta Road while the race was still in progress. She was rushed to the Chilaw Hospital, but was pronounced dead on admission.

Anjali Isurika aged 13 was the second victim who died while practising for the Zonal Sports Meet on February 18. She was a student of Gnaneswara Maha Vidyalaya in Villorawatte, Moratuwa. Anjali who complained of a severe pain in her abdomen collapsed to her death.

The third victim, an Advanced Level student of Rivisanda Central College in Aranayake was taking part in a 5,000 metre marathon race for her school’s sports meet on February 26. Hashini Anusha who could complete only several hundred metres in the marathon collapsed. She was admitted to the Mawanella Hospital but succumbed to her ailments prior to the admission. Her death was due to a rare cardiac ailment.

In the fourth incident, the victim named Lakshitha Madushan (16) a student of Kandanegedara Viduhala in Pannala had taken part in a 5000 metre marathon organised by the Youth Brigade Kuliyapitiya on March 19. Lakshitha could complete about 800 metres before he collapsed on the road. He was rushed to the Kuliyapitiya Hospital but was pronounced dead upon admission. It was reported that the victim was suffering from fever for about a week prior to the race. His funeral was conducted in Pannala on Thursday. The result of the Post-Mortem is yet to be announced.

Athlete’s Heart

‘Sudden cardiac death’:

Physicians define “sudden death” in young athletes (women as well as men, ages 35 and younger) as a non-traumatic, non-violent, unexpected death due to cardiac causes within one hour of the onset of symptoms. One study estimated that the incidence of sudden cardiac death in unscreened men during exercise is 1 in 280, 000 per year. In studies of the risk of death in marathons, it’s been estimated that one death would occur in 50,000 - 88,000 marathon finishers. In a study published by Dr. Lewis G. Maharam with Dr. Steve Van Camp in 2004 revealed that the risk in distances between 10 kilometres and half-marathon was significantly lower; 3.1 deaths per million finishers.

Causes

Exercise causes normal blood flow and electrical changes seen on ECG. During intense aerobic exercise, the oxygen consumption of muscle tissue increases and cardiac output must rise to meet the demands. Over time, aerobic training results in increased left ventricular mass, decreased resting heart rate, increased ventricular stroke volume, and increased cardiac output, among other effects. This is called an “Athlete’s Heart” - it is normal and nothing to worry about.

There are enlarged heart conditions that can lead to “sudden death.” Although more than 20 pathologic entities have been identified as causes of sudden death in young athletes, a few lesions are responsible for most of these deaths that are reported.

Some of the common ailments found in the victims are Hyperpertrophic Cardiomyopathy, Coronary Artery Abnormalities, Myocarditis, Marfan Syndrome and Electrophysiologic Abnormalities.