UNDER THE MICROSCOPE

A 14-year-old student recently collapsed while playing football and died. It was attributed to heat stroke, since temperatures were starting to rise to heat-wave levels. But was it really heat stroke? Or did he have another cause of death? Young men engaging in sports even in the hot summer sun do not normally drop dead suddenly.
Unfortunately, there was no report of a postmortem on the deceased, which could have shed light on the actual cause of death. There are many reports of sudden deaths in young persons, mainly male, which have been found to be due to cardiac causes. The estimates of the occurrence of sudden cardiac death in young people are from one in 50,000 to one in 80,000 each year.
Causes of sudden cardiac death in the young include heart arrythmias (e.g., long QT syndrome, Brugada syndrome, and Wolfe-Parkinson-White syndrome), congenital or acquired; thickening of the heart muscle (hypertrophic cardiomyopathy); congenital heart defects; and blunt chest trauma.
Blunt chest trauma was recently also in the news when an American football player collapsed and went into cardiac arrest after being tackled by an opposing player. This phenomenon, known as “commotio cordis” (Latin for agitation or disruption of the heart), is the result of a blow directly over the heart at a critical instant during the cycle of a heartbeat. It is 97 percent fatal if not treated within three minutes. Fortunately for the football player, a cardiac defibrillator was available at the stadium and he was successfully revived with it.  He later resumed playing football professionally.
Back to the local fatality. It is important that an autopsy should have been done, not only to rule out causes other than heat stroke but also because the findings may have a direct bearing on the other members of the family in case of congenital anomalies or abnormal heart rhythms. Our forensic pathologists, Drs. Fortun and Lim, should have been consulted on it, and an autopsy should have been performed. Unfortunately, in our local setting, the subject of death is deemed taboo. We shy away from any reminders of mortality when it is part and parcel of life. We should deal with death in a rational manner and treat it as worthy of discussion so we can understand and prevent it from happening when it is preventable.
Surely we can’t just say, no more sports during summer, since it is also important for physical fitness and mental health (competition brings out the best and sometimes the worst in people). There are warning signs, though, which can be screened for, before anyone is allowed to engage in sports. If fainting occurs during exercise or strenuous activity, that could mean a heart problem. Similarly, unexplained shortness of breath or chest pain at rest or with mild activity, or a family history of sudden cardiac death should also trigger a health checkup.
I had the experience of dealing with the sudden death of a man in his late 30s who had been playing basketball regularly with his buddies. He just collapsed and died suddenly during a game. The family was in shock, of course, but had the sense to request an autopsy, which showed atherosclerotic heart disease due to familial hypercholesterolemia. It turned out an older brother had also died suddenly at a young age. The other siblings are now aware of their possible health condition and hopefully are seeking professional help.
As for schools, it will help if all will acquire a cardiac defibrillator  and have several of their staff trained on how to use it. Had it been available at that school, the outcome might have been different. Precious minutes were wasted transporting him to a local hospital. It seems that neither first aid nor basic life support and resuscitation were administered on site, which might have spelled the difference.
This begs the question: How prepared are our schools for medical emergencies? Time and again, we read about health emergencies in schools where all they did was rush the victims to the hospitals. We need to teach our teachers and other school staff basic life support (BLS), just as we do in hospitals. Without such training, they can only wring their hands and panic.
There are regular fire and earthquake drills in schools, but we hardly hear about medical-emergency drills or training. It’s about time we institute changes to prevent more untimely deaths in our schools, such as equipping them with cardiac defibrillators and teaching them basic life support, which does not cost much other than the purchase of a mannequin for practicing cardiopulmonary resuscitation. It’s time the Department of Health cooperated with the Department of Education on this. Our teachers need to know basic life support. Let’s put the ₱150 million Confidential and Intelligence Fund to good use. Let’s do it!