‘It can be hard to spot a concussion, but we’re hoping to change that’

The faster pace of games, more intense tackling, and the bulking-up of players pose a greater risk of concussion, writes Dr Alan Byrne.

Dr Alan Byrne

AS THE REPUBLIC of Ireland’s team doctor and as Medical Director of the FAI and of Advanced Medical Services, the prevention, diagnosis and management of concussion among sportspeople is something I feel very passionate about.

The signs and symptoms of concussion are not always evident at the time of the injury which is a challenge and one of the biggest dangers and risks posed to players, especially amateur and under-age players who don’t have the same level of medical expertise available to them as elite and professional players.

International research and a growing body of evidence from domestic sports suggests that sports-related concussion is a significant problem. A number of developments in Irish sport such as faster pace of games, increased and more intense tackling, and the bulking-up of players pose a challenge for sporting organisations, schools and players alike.

However, thankfully, we are seeing a more proactive approach to managing and reducing the risks of sports-related concussion.

As Medical Director with Advanced Medical Services, we felt there was a real need for a concussion evaluation and management programme for amateur and underage players. Schools and sports clubs across Ireland could greatly benefit from the medical support and expertise provided by our new service Concussion Management system, which is endorsed by the IRFU.

Helping those who may have suffered a concussive episode

ImPACT is designed to bring peace of mind to those who may have suffered a concussive episode and ensure they continue to follow correct rest and recovery protocols.

The service includes performing a baseline neurocognitive test which is done ideally at preseason. The test take approximately 30 minutes and includes the recording of the participant’s verbal memory, visual memory and reaction times. The software used is considered the most scientifically validated computerised concussion evaluation software and has tested over 8 million people.

In the event that a player has suspected concussion at some stage following their baseline test they will be seen by one of our team of doctors for a post injury test and clinical evaluation.

The goal of our service is to ensure that we manage each player’s concussion individually ensuring they don’t return to school, work or to the playing field too soon.

Concussion is an issue that needs to be taken seriously by all those involved in sport, at all levels.

So what is concussion?

Concussion is a brain injury and in its simplest form can be described as a disturbance of brain function. Concussion can be caused by either a direct blow to the head, face, neck or elsewhere on the body with an impulsive force transmitted to the head.

There are many symptoms of concussion, common ones being headache, dizziness, memory disturbance or balance problems. Loss of consciousness, or being ‘knocked out’, occurs in less than 10% of cases and loss consciousness is not required to diagnose concussion.

Who is at risk?

Concussion can happen at any age. However, children and adolescents (18 and under) are more susceptible to concussion, take longer to recover, have more significant memory and mental processing issues, are more susceptible to rare and dangerous neurological complications including death caused by a single or second impact – as are those who have a history of previous concussions, and who may take longer to recover.

Tips on how to recognise concussion

If any of the following signs or symptoms are present following an injury the player should be suspected of having a concussion and immediately removed from play or training.

The visible clues of a suspected concussion are a player who is: lying motionless on the ground, is slow to get up, unsteady on their feet, experiencing balance problems or is falling over, is grabbing or clutching head, has a dazed, blank or vacant look, is confused or not aware of plays or events, has a suspected or confirmed loss of consciousness and/ or a loss of responsiveness.

As the saying goes – ‘if in doubt, sit them out’.

Dr Alan Byrne is the Republic of Ireland’s team doctor and is the Medical Director of the FAI and of Advanced Medical Services.

To learn more about Advanced Medical Services concussion service ImPACT visit www.advancedmedicalservices.ie or call 1890 300 333.


IRFU Supports ImPACT for Amateur And Underage Players


AMS launch ImPACT – a Neurocognitive Concussion Tool

Neurocognitive Concussion Tool
From left to right: Barry Fitzpatrick, St Michaels College, Dr Rod McLoughlin, Medical Director, IRFU, Ed Donovan, CEO Advanced Medical Services (AMS), Donncha O’Callaghan, Munster & Ireland Rugby player, Scott Penny, St Michaels College

IRFU supports use of ImPACT for amateur and underage players

Advanced Medical Services (AMS) today announced the launch of ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), a neurocognitive tool for the identification of prolonged concussive symptoms, for amateur and underage sports players.

The computerised neurocognitive evaluation system, already used by elite sportspeople, will be available to schools and clubs across all sports and delivered by the Advanced Medical Services medical team.

The tool provides an accurate assessment system to identify prolonged concussive symptoms and can help to alleviate player or parental concerns in relation to rest and recovery following concussive episodes.

Internationally, ImPACT is considered the most scientifically validated computerised concussion evaluation system and has been tested on over 8 million people.

ImPACT Concussion Management System involves a 20 minute computerised neurocognitive test which has been scientifically validated to measure neurocognitive abilities related to brain function from which the data is recorded. The initial test is often referred to as the baseline test. This test will be available to rugby club and schools players at a cost of €50.

Ed Donovan, CEO of Advanced Medical Services, which also operates the ‘Heartaid’ cardiac programme that has carried out over 51,000 screenings, said:

“In Ireland we are seeing a more pro-active approach to managing and reducing the risks of sports-related concussion. The signs and symptoms of concussion are not always evident at the time of the injury and the ImPACT system is designed to bring peace of mind to those who may have suffered a concussive episode and ensure they continue to follow correct rest and recovery protocols.”

The IRFU’s head of Medical Services, Dr Rod McLoughlin said: “The IRFU’s post-concussion return to play protocols are among the most conservative in the world to ensure that amateur players are fully recovered before they return to play or train.

We are pleased to support AMS’ launch of ImPACT testing as an additional service for those amateur players who wish to use it.

While the system will never be used to reduce the minimum mandatory return to play timelines of 21 days for adults and 23 days for players under 20 years of age, it can be useful to those with ongoing symptoms to ensure that the player is not, for example, returning to school, work or the playing field too soon.”

Following a suspected concussion the player will undergo a post injury test where the data is compared against the baseline test result.

Medical doctors who are trained and experienced in concussion management will also carry out a clinical assessment of the player and advise on a safe return to play.

BOOK YOUR SCHOOL OR CLUB IN TODAY!
Call: 1890 300 333 or email screening@ameds.ie

Former Meath captain Shane McAnarney shows the scar of the heart surgery which saved his life

Former Meath captain Shane McAnarney has revealed the extent of the serious cardiac condition that has forced him out of Gaelic football for good.

McAnarney, who is recovering from a double bypass operation he underwent eight weeks ago, was told that his heart could have stopped at any time due to the exertions involved in being an elite sportsman.
Damage to the wall of one of his blocked arteries appeared to confirm that the 2012 Leinster final captain had even suffered a mild heart attack at some stage, which went undetected.

“The one (artery) that was blocked completely, there is damaged tissue around the wall, so I did have a slight heart attack at some stage that I didn’t realise or know about,” he said.
McAnarney underwent surgery after two blocked arteries were discovered last July, following routine cardiac screening of the Meath squad in April.

He admitted he was lucky that such a programme was in place for him to avail of and has implored other players to take up the opportunity.

He also paid tribute to the Gaelic Players Association, which has met the



Atrial Fibrillation – A silent but deadly condition

Fit mother of two discovered huge risk of stroke after routine heart screening

Sinéad Hamill at her home in Stillorgan. Photograph: Cyril Byrne

Sinéad Hamill at her home in Stillorgan. Photograph: Cyril Byrne

              

I was a fit and healthy child and teenager, playing volleyball, basketball and tennis in school and riding horses until I was pregnant with my second child, Dawn, who was born five years ago.

 

 

In fact, we are a fit family. Dawn and her sister, Hazel (8), play Gaelic football and swim. Hazel also plays tennis and basketball and is in an athletics club. My husband, Tony, does triathlons and I play Gaelic football and run in marathons.

I took the free HeartBeat screening after I received an offer with the annual renewal letter from my private healthcare insurance provider, Laya. I hadn’t had any annual health check-ups in recent years so I just decided to go along for the screening in July of last year.

Electrical malfunction
My blood pressure was taken. My BMI (Body Mass Index) was calculated and I was given an electrocardiograph test. The nurse immediately said that she noticed an irregularity on the ECG readout. I then went into the doctor who asked me about my exercise levels.

I explained that I was training for the Dublin marathon in October and was planning to ramp up to longer runs over the next three months. He explained how the ECG showed that I had atrial fibrillation (an electrical malfunction in the heart beat) and that I needed to see a cardiologist to have it sorted out.

The HeartBeat team faxed my GP the results of the screening and he rang me back straight away. He knows I run and is fairly fit himself but he explained how important it was that I have the irregularity investigated. “It’s a little more than a heart murmur. You’ll have to stop running and football training until you find out what’s causing it,” he told me.

He gave me a prescription for a form of aspirin to thin the blood while I awaited an appointment with a cardiologist.

Valve defects
Of course I Googled the condition and realised that while the more common form of AF was a racing heartbeat (with more than 200 beats a minute) and palpitations, I had a form in which my heart skipped a beat every one in four beats. I still had to find out what was causing it.

The cardiologist did an echo ECG which didn’t show up any valve defects or fibroids in my heart. What it did show though was the lower chamber of my heart was enlarged. We discovered there wasn’t enough blood being pumped down from the upper chambers (right and left atria) into the lower chambers of my heart (right and left ventricles).

The problem with this is that a blood clot can form if the blood is not being pumped enough and this clot can be passed out of the heart into another part of the body. If the clot lodges in an artery in the brain, this can cause a stroke. I was told that I was five times more likely to have a stroke than most people.

Meanwhile, I got all of my family – my three sisters and my brother – to have ECGs to check if they also had the condition. It turned out that they hadn’t so that ruled out a genetic component even though our mother died of a stroke and heart attack at 73. She also had high blood pressure and smoked, neither of which I had.

The cardiologist suggested I have a cardiac MRI scan to check that there was no underlying fault in my heart. Meanwhile, he prescribed a stronger blood-thinning medication.

The MRI scan didn’t show up any fault in my heart. The next step was to have a cardioversion, a procedure under general anesthetic which would send an electric shock through my heart to get it to stay in rhythm. I was told that there was a 50 per cent chance that this operation would bring my heart beat back to normal but that the longer one had atrial fibrillation, the less likely it would work.

I was much younger than any other patients who have the operation but I still didn’t know how long I had the condition.

Within five days of the operation, I knew my heart had gone out of rhythm again. I felt sluggish. I got up and sat on the bed, took my pulse and could feel my heart out of rhythm again. Another cardioversion operation was scheduled for six weeks after the first and while that worked, the cardiologist also put me on betablockers to keep my heart in rhythm.

Betablockers
On a more recent check-up with the cardiologist, my betablocker prescription was reduced from two tablets a day to one and I will have to take these for the rest of my life. My blood-thinning medication was also changed to a lower dose one.

The only other option for me is to have pulmonary aversion – a surgical procedure which will cauterise a vein at the back of my heart to change the electrical signal from the top to the bottom chamber. While I don’t like the idea of being on medication for the rest of my life, I don’t have any symptoms at all so the cardiologist sees no rush to do such a procedure.

The cardiologist has told me that 50 per cent of people with atrial fibrillation don’t have any symptoms, but it’s the biggest cause of stroke. Yet because my heart is perfect – apart from the electrical malfunction in its beat, the chances of me having a stroke are much less than other people with AF who have defects in their heart as well.

Overall, I have been told that my fitness levels have helped me. I’m back running again and back playing football. I haven’t decided for definite yet, but I plan to do the Dublin Marathon in October.

 



Heartaid takes the field to highlight cardiac problems

Saturday, March 24, 2012

By a quirk of fate Ed Donovan was in London last Saturday when Fabrice Muamba collapsed in White Hart Lane.

Work had brought the founder of Heartaid, the only mobile cardiac screening company in Ireland, to the English capital. Ever since they inked the contract with the GPA to provide the service to all inter-county senior football and hurling squads, Donovan has been doing the rounds putting elite GAA panels through the test.

He had been out in Ruislip testing the members of London’s football and hurling setups when he returned to his hotel room last Saturday to take in the Ireland-England Six Nations game.

"I flicked over to Sky Sports after the match and it was all over the news about the Bolton player collapsing on the pitch," he said.

"It was a coincidence really that I happened to be over doing screening at the time. It was very sad to see but I also thought it was great to see the brilliant reaction of the medical staff present. Even this week I’ve found, by the amount of enquiries we’ve got, that the story has raised awareness. It’s unfortunate it takes a serious situation like that for headlines to be generated."

The subsequent avalanche of tributes and messages of support to Muamba this week has been heart-warming, yet has also thrown the issue of cardiac problems amongst sports people into the spotlight. Donovan’s background is originally in healthcare management and, having worked in the US for a radiology group, the Cork native returned to work in Blackrock Clinic in Dublin. The tragedies involving Irish sports stars like Cormac McAnallen and John McCall got him thinking about the issue of SADS (Sudden Adult Death Syndrome).

"I wondered what was the cause of it and was there any solution. I read up on it and found that in countries like Italy, anyone who plays organised sport has to get the mobile cardiac screening done. That has reduced SADS deaths in Italy by 89% over the last 25 years.

"I consulted with a lot of cardiologists both at home and abroad and the feedback was that there was a need for cardiac screening."

It took Donovan, whose sporting background is in rugby having played for Cork clubs UCC and Dolphin, six months to get the pieces in place before Heartaid was born at the end of 2010. A study last year by the GAA’s Medical Advisory Committee found all players under 35 should receive cardiac screening and this led Donovan to contact officials about offering his services to inter-county teams.

"We’d talked to a lot of sports medicine doctors and they were aware of us. I made contact with the GAA and Dessie Farrell in the GPA and told them about our service. We did a pilot with the Dublin minor team, which Dessie managed, last year in February 2011. After a successful pilot, we agreed a contract with the GPA to screen test all inter-county hurling and football teams."

The test that Heartaid offers is simple. On the day we meet, the sports scholarship students in UCC are undertaking the cardiac screening with Kevin O’Driscoll and Liam Jennings, members of Cork’s All-Ireland U21 winning side in 2009, and current Kerry U21 footballer Mark Reen amongst those being tested. Donovan guides me through the process with the first step involving the completion of a personal and family history questionnaire. A physical examination with a doctor then takes place where an individual’s Body Mass Index (BMI) is calculated. It’s followed by a heart exam with a stethoscope to detect any murmurs or irregular heart rhythms before testing for radial and femoral pulses. The final step involves a 12-lead electro cardiogram examination with cardiac technician Jimmy Ashraf conducting the test. Within 15 minutes it is completed and in 10 days I receive the results which are also relayed to my GP. In an inter-county setup, a team doctor also receives the results. People are sometimes unsure what to expect," admits Donovan. "But the test is painless and doesn’t take long. If something is picked up, it can then be tested further."

The contract with the GPA ensures Donovan is hitting the road most weekends. When we met he had been screening the Laois footballers the previous Saturday morning and went on to test the two Derry inter-county squads the following day. Next weekend the Armagh hurlers are his port of call. But the service is not just GAA based with rugby sides like the Connacht academy and the senior team also getting tested while Irish hockey player John Jermyn is one of those who has a testimonial supporting the service on their website.

"We’re the only company of the kind currently in operation in Ireland. But I think it was definitely needed. The goal is to reduce the cases of SADS in Ireland and raise awareness, so that’s what we’re trying to do."

* For more information see www.heartaid.ie

Read more: http://www.irishexaminer.com/sport/kfididcweyid/rss2/#ixzz1sNbIph4u



Tyrone squads latest for Cardiac Screening by HeartAid

Ed Donovan of Heartaid, Conor Gormley & Mark Donnelly – Tyrone Senior Footballers
Ed Donovan of Heartaid, Conor Gormley & Mark Donnelly – Tyrone Senior Footballers

Over 60 Tyrone footballers and hurlers were the latest to undergo the GPA’s cardiac screening initiative which is being provided to all county squads over the coming months.

As part of the GPA’s Health and Wellbeing Programme all county players are entitled to be screened and the mobile screening unit has visited 38 county squads all over the country since the initiative commenced earlier this year.

The tragic loss of Tyrone star Cormac McAnallen in 2004 thrust the issue of Sudden Cardiac Death to the fore in Irish sport and led to the provision of automated external defibrillators in many sports clubs nationwide. It also highlighted the need to promote cardiac screening for young athletes.

The GAA’s Medical and Scientific Committee subsequently carried out an extensive body of work in this area and issued a number of recommendations for the screening process. Given that up to 100 young persons (under 35 years) die each year in Ireland from Sudden Adult Death Syndrome, it also recommended that all players should be screened.

In line with the GAA’s Medical and Scientific Committee’s Cardiac Proposals, the GPA, in association with mobile cardiac screening service Heartaid, is providing the screening facilities for each squad.

The Cardiac Screening Programme is funded by the GPA and is seen as a critical welfare component of the Association’s Player Development Programme.

The Development Programme, supported by the GAA, provides a comprehensive suite of support services for inter-county GAA players in the areas of Career Development, Education, Health and Wellbeing, Life Skills and Benevolent Support.

 



GPA kick on with Cardiac Screening

Friday, October 28, 2011

MORE than half of the senior inter-county hurlers and footballers in the country have been screened forheart problems by a new company working with the Gaelic Players’ Association, it has emerged.

Ed Donovan of mobile cardiac screening company Heartaid says the remaining hurlers and footballers will be screened in the coming weeks, but he stresses the need for sportspeople operating at all levels to be screened for cardiac problems.

"We’re a service provider to the GPA but we don’t just work with elite sportspeople — we’ve screened the Connacht [rugby] Academy and various other sports clubs such as Church of Ireland Hockey Club.

"It’s mandatory in Italy, for instance, where figures for Sudden Adult Death Syndrome have dropped by 89% as a result."

The unexpected and untimely death of Tyrone Gaelic footballer Cormac McAnallen in 2004 brought the necessity of cardiac screening to the fore.

Donovan explained: "If a club chairman rings and asks about the service, we’ll arrange a convenient time — usually in the evening or at the weekend. We send a designated liaison person in the club a time sheet and they allocate each player a time.

"They send back the time sheet and we text the players to remind them. The day of the testing we set up the clinic in a changing room or committee room in the club. The player arrives, fills out a family history questionnaire, signs a consent form and then he or she is seen by our doctor, who’ll carry out various basic tests — blood pressure, body mass index and so on.

"The player is then seen by our cardiac technician, who does a 12-lead electrocardiogram, which helps to pick up genetic cardiac abnormalities, particularly in young people.

"The player’s free to leave then, and we send the information to a consultant cardiologist. He reviews the information and a report is sent to each person, or their guardian/parent depending on age, within a working week. In the event of something being found, we also write to their GP."

Donovan adds that a screening is valid for two years, with best practice recommending sportspeople be tested every second year. For more information log onto heartaid.ie

Read more: http://www.irishexaminer.com/ireland/kfqlcwkfeyoj/rss2/#ixzz1dK6RKq3x


GAA still not scoring well with Cardiac Screening

GAA still not scoring well with cardiac screeningMonday October 03 2011 The awareness and uptake of cardiac screening to detect potential heart problems among GAA players is still too low, according to a new study. The GAA introduced cardiac screening in 2006 following the high-profile death of Tyrone All Star Cormac McAnallen, who died of sudden cardiac death two years earlier. Many young people do not have any signs or symptoms before sudden cardiac death so players may have undetected heart conditions, which leave them at risk. It now advises that screening is the most effective way to identify players at risk over the age of 14. This involves completion of the GAA’s cardiac screening questionnaire, a physical examination and an ECG, which records the electrical activity of the heart. A team from the Department of Rheumatology, Sports and Exercise Medicine at University College Cork recently investigated how aware GAA players were about the service and what the level of uptake is. Data was collected at one hurling competition and one football competition in Cork and it involved a questionnaire handed personally to each player. It found that out of 880 players, 258 (29pc) were aware of the GAA cardiac screening programme. Sixty-two (seven per cent) players had completed the process. They said that media was the most common source of informing them about the issue (39pc). Seven per cent of those asked had been told about it by a doctor. The study found that players with inter-county experience were more informed and more likely to avail of the screening that those who played locally. "Ulster fared best in both awareness levels (42pc) and uptake levels (11pc)," said the research. The authors pointed out that studies had proven that cardiac screening could significantly reduce rates of sudden cardiac death amongst athletes. "It is clear from our study that both awareness and uptake levels are well below the desired target," reported the authors. "A more effective and robust system must be put in place in order to protect our athletes." Most of the conditions that cause sudden cardiac death can be treated, demonstrating how important screening is. Around 100 or more people under the age of 35 die in Ireland every single year from it. It does not just affect sports people but if someone has a serious undetected heart problem, over exertion during sport can act as a trigger. Risk factors include: ?A family history of unexplained death (including cot death) in people under 35 years of age. ?Breathlessness on effort. ?Chest pain on effort. ?Dizziness, fainting and blackouts with no known cause. ?Fast heart rate that comes and goes, even when you are resting. ?Palpitations due to an irregular heart rhythm.


Cardiac Screening for 2,000 GAA Players – Irish Times

MOBILE CARDIAC SCREENING FOR 2000 GAA PLAYERS

Irish Times-Health
Tuesday, 29th March 2011

Mobile cardiac screening for 2,000 GAA players

Brian O’Connell

Heartaid, a new mobile cardiac screening service founded by Cork man Ed Donovan, has agreed a deal with the Gaelic Players Association (GPA) to provide screening to inter county players.

The programme, which will be available to more than 2,000 players across the country, will be funded by the GPA, and follows recommendations made by the GAA’s medical, scientific and welfare committee.

Recent reports have found that the incidence of Sudden Adult Death Syndrome (SADS) is higher in the Republic of Ireland than many other European countries.  Studies have shown that cardiac screening is an effective way of assessing risk in young persons in particular. 

Heartaid provides mobile cardiac screening to schools, clubs and organisations involved in sport.  The programme began two weeks ago with members of the Kildare senior football team, and will continue for six months.  The cardiac screening unit is brought to t allocation of the player’s choice, and each player is asked to fill out a personal and family history questionnaire.  They are then examined by a medical doctor and submit to an electrocardiogram.  The result of these tests are reviewed by a consultant cardiologist and a final report sent to each player.

Mr. Donovan said:  “In Italy, cardiac screening is mandatory for people involved in competitive sports.  They have reduced the incidents of sudden cardiac death by 89 per cent”.

 


Heartaid in the Irish Medical News

Niamh Cahill looks at newly established mobile cardiac screening service Heartaid and examines how it is helping to detect potentially life-threatening cardiac conditions in senior inter-county GAA players.

It is estimated that at least one person under the age of 35 dies suddenly every week in Ireland from cardiac diseases such as cardiomyopathy or sudden cardiac death syndrome (SCDS). However, the lack of accurate statistics has meant that it is still unknown exactly how many people die from SCD syndrome and how Ireland compares to other countries in terms of prevalence. A report titled, “Sudden Cardiac Death in the Young”, published late last year by the Sudden Cardiac Death in the Young Registry at the Mater Hospital examined incident rates between 2005 and 2007. It found that 119 confirmed SCD cases occurred between 2005 and 2007 – 75 per cent of which occurred in men.

The incidence of SCD in those aged between 15-35 years in Ireland was 2.68 per 100,000 a year. “The incidence rates in this report may be an underestimation of the true figure due to missing or inadequate data resulting in case exclusions,” the report states. “The incidence is higher than in other similar European studies performed in Iceland and in Sweden. The reason for this is unclear and requires further investigation.” The registry, established in 2008, will conduct studies for the years 2008 onwards and has recommended that “a national standard protocol for the performance of postmortems in cases of SCD should be agreed and implemented”. As efforts continue at a national level to accurately record the number of deaths from SCD, Heartaid, Ireland’s first private dedicated cardiac screening service, is providing screening to more than 2,000 GAA players.

By the end of the year it is envisaged that all senior intercounty GAA players will have been given the opportunity to undergo potentially lifesaving cardiac screening. Based in Cork, Heartaid (www.heartaid.ie) is conducting screening at the behest of the Gaelic Players Association (GPA) and has so far screened more than 19 teams and over 500 players. Founder and Director of Heartaid, Mr Ed Donovan, explained that one or two players from each team is usually found to have an abnormal ECG, heart murmur or simply something in their family history that suggests they may need to go for further investigation. Mr Donovan has never been directly affected by SCD, but developed an strong interest in the area through his work in healthcare management. “The more research I did the more I thought there was a need for screening.

I thought if I can make it accessible and affordable and with the right medical people it would work,” he told IMN. Mr Donovan attends every screening along with a GP, medical doctor and cardiac technician. Each player is asked to fill out a questionnaire to obtain as much information as possible about their health and level of physical exercise. A physical examination is subsequently undertaken where blood pressure and other measurements are taken to search for signs of cardiac diseases or irregular heart rhythms. Some of the risk factors include fainting and blackingout for unknown reasons and a fast heartrate that comes and goes, even when resting. Taking part in sports does not cause SCD but physical exercise can trigger a previously undetected heart problem, causing sudden cardiac arrest. Heartaid has also conducted screenings in golf and hockey clubs and the service may undertake screenings in schools in the future.

Aside from sporting clubs, Heartaid also operates a screening clinic once a month in Cork City where individuals concerned about SCD can receive information or be screened. Cork-based GP Dr Ed Donovan, Mr Donovan’s father, has conducted screenings at the clinic and told IMN that about 70 per cent of attendees are male. He maintained that a lot of concerned parents make appointments for their children to be seen at the clinic due to a concern about SCD and the fact that inherited cardiac disease is known to cause cases of SCD. He opined that screening is essential for everyone participating in any type of sports activity and especially for those who have a family history of cardiac disease. Mr Donovan went even further and suggested that “based on research in other countries it definitely warrants consideration that it be mandatory” in Ireland. In Italy, cardiac screening is mandatory for anyone taking part in organised or competitive sports. This has led to a reduction of up to 89 per cent in SCD, Mr Donovan remarked. “If the same situation existed in Ireland and it was mandatory the results could be similar to Italy,” he said.

The possibility of screening becoming mandatory unfortunately seems like a distant prospect, however. Last month Health Minister James Reilly stated that the Department of Health had no plans to create a scheme for grants to purchase automated external defibrillators (AEDs). In response to a Parliamentary Question on the matter by Independent Deputy Tom Fleming, he stated that, “my Department does not propose to introduce a scheme for grants to be made available for the purchase of defibrillators or other such equipment. Acquiring concrete data on SCD remains a priority and its benefits cannot be outweighed. The “Sudden Cardiac Death in the Young” report stresses that accurate data is essential to “assist health care planners to understand the potential impact of genetic testing facilities and national family screening services, and to examine any change in disease frequency over time. “Furthermore, such knowledge of the burden of SCD in a country will assist in improving awareness of this lethal condition for health care providers, coroners, and pathologists, as well as for the general population themselves.”


Heartaid covered in the Irish Medical News -June 2010

Helping to make hearts healthy

 

Niamh Cahill looks at newly established mobile cardiac screening service Heartaid and examines how it is helping to detect potentially life-threatening cardiac conditions in senior inter-county GAA players.

It is estimated that at least one person under the age of 35 dies suddenly every week in Ireland from cardiac diseases such as cardiomyopathy or sudden cardiac death syndrome (SCDS). However, the lack of accurate statistics has meant that it is still unknown exactly how many people die from SCD syndrome and how Ireland compares to other countries in terms of prevalence. A report titled, “Sudden Cardiac Death in the Young”, published late last year by the Sudden Cardiac Death in the Young Registry at the Mater Hospital examined incident rates between 2005 and 2007. It found that 119 confirmed SCD cases occurred between 2005 and 2007 – 75 per cent of which occurred in men.

The incidence of SCD in those aged between 15-35 years in Ireland was 2.68 per 100,000 a year. “The incidence rates in this report may be an underestimation of the true figure due to missing or inadequate data resulting in case exclusions,” the report states. “The incidence is higher than in other similar European studies performed in Iceland and in Sweden. The reason for this is unclear and requires further investigation.” The registry, established in 2008, will conduct studies for the years 2008 onwards and has recommended that “a national standard protocol for the performance of postmortems in cases of SCD should be agreed and implemented”. As efforts continue at a national level to accurately record the number of deaths from SCD, Heartaid, Ireland’s first private dedicated cardiac screening service, is providing screening to more than 2,000 GAA players.

By the end of the year it is envisaged that all senior intercounty GAA players will have been given the opportunity to undergo potentially lifesaving cardiac screening. Based in Cork, Heartaid (www.heartaid.ie) is conducting screening at the behest of the Gaelic Players Association (GPA) and has so far screened more than 19 teams and over 500 players. Founder and Director of Heartaid, Mr Ed Donovan, explained that one or two players from each team is usually found to have an abnormal ECG, heart murmur or simply something in their family history that suggests they may need to go for further investigation. Mr Donovan has never been directly affected by SCD, but developed an strong interest in the area through his work in healthcare management. “The more research I did the more I thought there was a need for screening.

I thought if I can make it accessible and affordable and with the right medical people it would work,” he told IMN. Mr Donovan attends every screening along with a GP, medical doctor and cardiac technician. Each player is asked to fill out a questionnaire to obtain as much information as possible about their health and level of physical exercise. A physical examination is subsequently undertaken where blood pressure and other measurements are taken to search for signs of cardiac diseases or irregular heart rhythms. Some of the risk factors include fainting and blackingout for unknown reasons and a fast heartrate that comes and goes, even when resting. Taking part in sports does not cause SCD but physical exercise can trigger a previously undetected heart problem, causing sudden cardiac arrest. Heartaid has also conducted screenings in golf and hockey clubs and the service may undertake screenings in schools in the future.

Aside from sporting clubs, Heartaid also operates a screening clinic once a month in Cork City where individuals concerned about SCD can receive information or be screened. Cork-based GP Dr Ed Donovan, Mr Donovan’s father, has conducted screenings at the clinic and told IMN that about 70 per cent of attendees are male. He maintained that a lot of concerned parents make appointments for their children to be seen at the clinic due to a concern about SCD and the fact that inherited cardiac disease is known to cause cases of SCD. He opined that screening is essential for everyone participating in any type of sports activity and especially for those who have a family history of cardiac disease. Mr Donovan went even further and suggested that “based on research in other countries it definitely warrants consideration that it be mandatory” in Ireland. In Italy, cardiac screening is mandatory for anyone taking part in organised or competitive sports. This has led to a reduction of up to 89 per cent in SCD, Mr Donovan remarked. “If the same situation existed in Ireland and it was mandatory the results could be similar to Italy,” he said.

The possibility of screening becoming mandatory unfortunately seems like a distant prospect, however. Last month Health Minister James Reilly stated that the Department of Health had no plans to create a scheme for grants to purchase automated external defibrillators (AEDs). In response to a Parliamentary Question on the matter by Independent Deputy Tom Fleming, he stated that, “my Department does not propose to introduce a scheme for grants to be made available for the purchase of defibrillators or other such equipment. Acquiring concrete data on SCD remains a priority and its benefits cannot be outweighed. The “Sudden Cardiac Death in the Young” report stresses that accurate data is essential to “assist health care planners to understand the potential impact of genetic testing facilities and national family screening services, and to examine any change in disease frequency over time. “Furthermore, such knowledge of the burden of SCD in a country will assist in improving awareness of this lethal condition for health care providers, coroners, and pathologists, as well as for the general population themselves.”

 



IRFU offers condolences to Robinson family

The Irish Rugby Football Union has offered it’s condolences to the family of Ben Robinson, the Ulster student who died after he collapsed while playing rugby on Saturday.

Ben passed away on Sunday evening. He collapsed while playing a match for Carrickfergus Grammar School on Saturday morning.

IRFU President Caleb Powell said: ‘It was with great shock and sadness that I learnt of the passing of Ben and I would like to take this opportunity on behalf of the entire rugby family across Ireland to pass the deepest condolences to Ben’s parents and family.

 

‘To lose such a young life is incredibly saddening and I would also like to pass my sympathy to his team mates and school friends in Carrickfergus Grammar School. The thoughts and prayers of Irish Rugby are with you all at this time.’


GAA issue update on Cardiac Screening

Dr Danny Mulvihill

Dr Danny Mulvihill

The GAA’s Medical Scientific & Welfare Committee has announced an update to its position paper on Cardiac screening following the completion of a two year research programme in which nearly 300 GAA players were examined in an attempt to assess the effectiveness of various screening methods.

Following consideration of the results of the programme and the most up to date international best practice guidelines, the GAA have advised that the most effective way to identify risk is for players over the age of 14 to undergo cardiac screening on one occasion.

It is also advised that this process be repeated before the age of 25. Players should consult their team or family doctor if they wish to get screened and screening should consist of completion of the GAA’s Cardiac Screening Questionnaire, a Physical Examination and an ECG.

 

The Chairman of the GAA’s Medical, Scientific and Welfare Committee, Dr Danny Mulvihill said: ‘The instance of Sudden Cardiac Death in the general populace under 35 is a rare occurrence and remains very difficult to predict. The study we undertook would indicate that cardiac screening along the lines we have suggested is the best predictor of potential risk.

He added that while no screening programme is 100% effective, it has been shown to help in identifying risk in the general populace. Dr Mulvihill also welcomed the recent report of the National Taskforce on Sudden Cardiac Death which had found that less than one in ten of all instances of the condition occurred while under exertion such as playing football or hurling.

The Medical Committee today also announced details of a new initiative being rolled out in association with the GPA which will assist doctors in interpreting ECG’s. Dr Muvihill explained: ‘Interpretation of ECG’s in athletes can present difficulties and where difficulties arise, the GAA in conjunction with the Gaelic Players Association (GPA) have implemented a programme whereby any doctors carrying out a cardiac screening programme for a GAA player will be able to send that ECG to the cardiac department in the Mater under Dr. Joseph Galvin to have a sports cardiology opinion on the ECG.’

He said that the availability of such a facility should prove extremely beneficial in assisting diagnosis.

The project will be funded as part of the player welfare initiatives being rolled out by the GPA in association with the GAA and follow similar initiatives undertaken in this area by the GAA including and training initiatives for club members, officers and match officials.


‘Mobile screening gets to the Heart of the matter’ -The Irish Times

BRIAN O’CONNELL

The organisers of a new service hope it will help to curtail the high incidence of sudden cardiac death syndrome

IT’S SATURDAY morning in the Lee Valley Golf Club near Ovens in Co Cork. Sets of clubs are unloaded from car boots as several mostly middle-aged men go through some stretching exercises. Others stuff chocolate bars and bottles of sports drinks into their pockets and stride purposefully towards the first tee.

Inside the clubhouse, former healthcare worker Ed Donovan is setting up his stall and showing his medical staff of one nurse and a doctor to their respective rooms. Donovan has recently set up a mobile cardiac screening company called Heartaid, having spotted a gap in the market for targeted cardiac services.

The screening this morning is specifically aimed at those under 35, in an attempt to arrest the high incidence of early sudden death syndrome in Ireland. Recent research shows that sudden cardiac death (SCD) here is higher than in many EU countries, with 119 deaths occurring between 2005 and 2007. This gives an incidence of SCD in the 15-35 age bracket of 2.68 per 100,000, with males twice as likely to die as females. The researchers went on to note: “The incidence is higher than in other similar European studies performed in Iceland and in Sweden. The reason for this is unclear and requires further investigation.”

I volunteered to attend Heartaid’s first screening. My consultation began with a health check by the doctor (and Ed’s father) Dr Edmund Donovan who takes patients’ blood pressure, does a routine check-up and listens to their heart rate. He also compiles a questionnaire to check for genetic symptoms.

“A lot of cardiac problems occur during sporting events, or potentially occur, especially if people are pushing themselves,” he says.

“It can be due to metabolic things, or it could be an inherent heart disease no one picked up on. It is like the old story of the fella who was never at the doctor a day in his life, but he died suddenly. This is the reason prevention is better than cure.”

One of the reasons Lee Valley Golf Club is happy to host the screenings is that in recent years two heart-related fatalities have occurred on the course. A defibrillator has been installed recently and, weeks after it was put in place, the club captain was called upon to use it.

Golf director David Keohane takes up the story. “A few months ago we had a captain’s prize and on our 12th hole a member had a heart attack out on the course. We had only recently had a defibrillator installed and on the day there were only four people trained in how to use it. One of the people trained was the captain and he was the only person here who could use the apparatus. So they rushed him out to the course in a buggy to use the defibrillator on him. This saved his life, so said the paramedics and the doctor.”

Keohane says that many in the sporting field are now more aware of sudden death syndrome, given some recent high profile deaths in the Irish sports community. “We’ll always support something to do with heart and screening. It is so in the news at the moment, between GAA and basketball people dropping dead,” he says.

“Some are trying to associate it with sports drinks or nutrition supplements. I played a lot of sport and go to the gym, and I know that if you have a ticking time bomb inside you, for whatever reason, you need to know about it.”

Back in the waiting room several club members and locals are queuing up to be seen by the medical staff. One of those, William O’Brien, recently stopped playing competitive rugby, and has become a lot more conscious about his health since.

“I’d have a check-up every now and again but never anything like this. I am 30 years old now and I gave up rugby about six months ago. When you get to your late 20s and 30s, you start taking health a lot more seriously. The big thing is when you hear about sudden death and fellows around your age dropping dead: you realise that these things do happen.”

Donovan checks my body mass index, completes a personal and family history questionnaire, and then I’m passed to a nurse specialist for an electrocardiogram. The test itself takes about 10 minutes. During it, I’m connected to a recording device through a series of leads. This in turn records the electrical activity of my heart. It will be read off-site by a specialist and the results assessed.

All in all, the consultation and the examination takes about 30 minutes and costs € 80 per person. Five days after the screening, the results of the electrocardiogram arrive by post. They are normal.

The hope is that the service will be rolled out nationally in the coming weeks, visiting schools, clubhouses and sporting facilities. “In Italy, it is mandatory for anyone who plays competitive sports to have cardiac screenings based on the service we are offering,” says Ed Donovan.

“They have reduced the instance of sudden cardiac death by 89 per cent, so it is proven that it works. I saw there were certain issues for people getting screened in Ireland. One was accessibility and the other was cost. By bringing this service directly to people, at an affordable price, we are hoping to change that.”


For more details see heartaid.ie or tel: 1890-300333


Concern at sudden cardiac death rate

THE INCIDENCE of sudden cardiac death (SCD) among young people in the Republic is higher than in a number of other European countries, according to a report.

The first report from the national register, set up to document all cases of SCD in those aged 15-35 in the State, says 119 deaths which occurred during the three-year period from 2005 to 2007 have been included on the register.

This gives an incidence of SCD among this age bracket of 2.68 per 100,000. The incidence among males was twice that of females.

“The incidence is higher than in other similar European studies performed in Iceland and in Sweden. The reason for this is unclear and requires further investigation,” the report says.

Dr Andrew Roy, cardiology specialist registrar at the Mater hospital, Dublin, and one of the authors of the report, said it was likely that genetic predispositions in different populations were responsible for the variations.

The overall incidence of SCD was estimated at 0.93 per 100,000 in Sweden between 1992 and 1999 among a similar age group and at 1.47 per 100,000 in Iceland.

“It is clear from these findings that SCD in the young, whilst a rare event at population level, represents a significant challenge in Ireland, with an estimated incidence of three cases every month. It can also be assumed that this figure is something of an underestimate,” the report says. Given the fact that inherited cardiac disease is known to cause cases of SCD, the importance of early family screening cannot be understated, the report adds.

Some 292 cases of possible SCD between 2005 and 2007 were examined before final figures were included in the register. Any cases where alcohol or drugs showed up in toxicology reports were excluded, which means the total numbers in the register may be an underestimation of the true extent of the problem.

Of the 119 confirmed SCD cases finally included in the register, some 46 per cent occurred while the young person was asleep. Just 8 per cent occurred while under exertion such as playing football, while the circumstances of the other 46 per cent were unknown or not stated.

Dr Roy said while SCD has traditionally been considered a young sportsperson’s illness and may have stopped some people allowing their children play, it was important to note many deaths did not occur while exercising.

A national taskforce on SCD was set up in 2004 in the wake of public concern about what appeared to be an increased incidence of sudden cardiac death among young sportsmen like the late Tyrone footballer Cormac McAnallen.

It recommended a register of all SCDs be compiled. The registry, which was set up last year, will report on sudden cardiac deaths for the years 2008 and 2009 by the end of next year and produce annual reports thereafter.



Miguel Garcia ‘continues to improve’ after suffering heart-attack during Spanish league game

Spanish second division side UD Salamanca have released a very positive statement about the health of player Miguel Garcia who ‘died’ for almost half a minute during Sunday’s match against Real Betis.

Garcia collapsed in the centre circle after suffering a heart attack early in the second half. The 31-year-old was revived on the pitch before being rushed to Salamanca’s University Hospital, where the club say his condition continues to improve following surgery.

Team physician Jose Ignacio Garrido said after the match that the player was legally dead for 25 seconds. He added that his playing days were almost certainly over.

Read more: http://www.dailymail.co.uk/sport/football/article-1323894/Miguel-Garcia-continues-improve-heart-attack-Spanish-league-game.html#ixzz1420GSqN2


Call for awareness of sudden adult death syndrome

Call for awarneness of sudden adult death syndrome

GREATER PUBLIC awareness is needed about sudden adult death syndrome, a coroner said yesterday at an inquest into the death of a girl who collapsed and died at a friend’s 18th birthday party. 

Nicole Campbell (16), of Barr na Háille, Claremorris, was dancing with friends at a house party in Ballindine on March 6th last when she appeared to faint. She died shortly afterwards despite efforts to resuscitate her. 

Dr Fadel Bennani, a consultant pathologist at Mayo General Hospital, said that in recent years there had been increasing evidence that such deaths may be due to faults within the electrical activity of the heart.

"It may run in a family," Dr Bennani said.

The pathologist explained that Dr Mary Sheppard, of the department of pathology at Royal Brompton Hospital in London, who had examined the case, had recommended that the family be apprised of the situation regarding sudden adult death syndrome.

After returning a verdict of sudden adult death syndrome in accordance with the medical evidence, coroner for south Mayo John O’Dwyer said such sudden deaths were unfortunately becoming more common.

"The public should be made more aware that the risks are there," the coroner said.

The inquest heard that Nicole, a student at St Colman’s College, Claremorris, was a friendly, outgoing person who loved music and was involved in her school musical.

She had been attending her friend Maura Callaghan’s 18th birthday party and was, according to her friends, "totally normal" before she collapsed.

At the conclusion of the inquest, the dead girl’s mother, Dorothy, said the family was "totally devastated at losing our beautiful Nicole".


Down Player dies during minor GAA match

GAA: A teenage GAA player collapsed and died during a minor football match in Co Down last night.

A doctor and a nurse who had been at the game in Rostrevor battled for 35 minutes in a bid to save Patrick Dinsmore’s life, at one stage using a defibrillator to try to resuscitate him.

With Down due to play Kildare in this Sunday’s All-Ireland senior football semi-final at Croke Park, SDLP councillor Michael Carr said: “This death has cast a shadow over everything. It’s every parent’s worst nightmare.”

Patrick, who was a pupil at St Colman’s in Newry was due to celebrate his 17th birthday tomorrow.

He had been playing for St Peter’s, Warrenpoint, against neighbours St Bronagh’s when he fell ill. He was standing on the pitch on his own when he collapsed.

Carr said: “This really is a devastating, utterly devastating, death of a fine young man.

“The local area is finding it hard to come to terms with it as the young lad was so well thought of and was taking part in something he loved, representing his local community.”



Healthy man, 25, collapses and dies playing Wii Fit game

Healthy man, 25, collapses and dies playing Wii Fit game

A ‘fit and healthy’ 25-year-old man suddenly collapsed and died in front of his horrified girlfriend and best friend as he played a computer game.

Tim Eves was ‘jogging’ on a Wii Fit games console as Emma Tuck and Lewis Hickin looked on, when he slumped to the floor.

The tragedy happened just hours after Tim had flown home from celebrating his mother’s 50th birthday in Portugal.

Devastated Emma, 26, said last night: ‘Tim was the best boyfriend anyone could have and the best friend a girl could have.

‘I love him loads and will miss him so much.’

Paramedics dashed to the house and rushed Tim, who had been fit and well, to hospital but it was too late.

The family were told he could have been killed by Sudden Adult Death Syndrome.

Also known as Sudden Arrhythmia Death Syndrome, it is a disorder of the electrical system of the heart.

Those with the condition are vulnerable to an abnormal heart rhythm. During exercise the heart may stop pumping out blood, causing the brain to become deprived of blood and sudden death.

The condition is estimated to kill 500 people a year.

Tim’s father, Alan, said: ‘He was just such a helpful, considerate and caring person.

‘He really threw himself into things and lived life to the absolute full.’ 

He added: ‘Tim packed so much into the 25 years that even if he had lived another 25 years he couldn’t possibly have made any more friends.

‘We all loved him so much.’

The tragedy occurred on March 4 at the home Tim shared with Lewis, 25, in Hopton-on-Sea, near Great Yarmouth, Norfolk.

He had just returned to England after visiting his parents at their Portuguese home and had spoken to them on the phone just minutes before he collapsed.

His mother June said: ‘We spoke to him on the phone when he was playing on the Wii machine.

Read more: http://www.dailymail.co.uk/news/article-1165796/Healthy-man-25-collapses-dies-playing-Wii-Fit-game.html#ixzz0wIT3a4Ox

 


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