How to Screen for Sudden Death - Dr. Jesse Santiano

Last night another athlete collapsed while playing. Imo Essien, a basketball player from Old Dominion University, collapsed while playing against Georgia Southern yesterday.

As reported by Wavy,

Essien, a sophomore guard, appeared to become weak, then collapsed during play in the first half of the contest.

After a few tense moments, Essien, who did not appear to lose consciousness, was helped to his feet and walked off the court with the help of the trainers. “He was responsive throughout and was able to sit with team for the duration of the game and travel back with the team,” read a statement from ODU.

“He is in good spirits and will work with the ODU Sports Medicine staff when they return to Norfolk.”

Less than a week ago, Damar Hamlin, a Buffalo Bills safety, had a cardiac arrest during a Monday Night Football against the Cincinnati Bengals.

Fortunately, Damar beat the odds and had a remarkable recovery, although he is still under observation and possibly going through more tests at the University of Cincinnati Medical Center.

But there are more; Real Science confirmed 1,653 athletes with cardiac arrests or serious issues, and 1,148 died.

Source: https://goodsciencing.com/covid/athletes-suffer-cardiac-arrest-die-after-covid-shot/

A systematic review of the literature by the Division of Pediatric Cardiology of the University Hospital of Lausanne in Switzerland found 1,101 Sudden Cardiac Deaths occurred from 1966 to 2004 in athletes less than 35 years.[1] That averages about 28 per year.

50% had congenital anatomical heart disease and cardiomyopathies, and 10% had early-onset atherosclerotic heart disease.[1] Studies like this prompted schools and sports organizations to screen for heart diseases before sports participation.

Fast forward to the COVID-19 pandemic, the single event that began in 2021 that explains the sudden deaths is the start of the COVID “vaccinations. Most schools and sports organizations mandated the COVID shots starting in 2021.

Myocarditis post-COVID shots

Myocarditis is an inflammation of the heart muscle. Myocarditis after COVID injections is not a conspiracy theory.

The National Institute of Health and the US Centers for Disease Control and Prevention recognize it. As early as June 2021, the US Food and Drug Administration warned against it.

Myocarditis

Acute myocarditis presents as chest pain or shortness of breath. Chest pain is due to spasms of the coronary arteries. Palpitations and syncope or loss of consciousness can happen due to ventricular arrhythmias like ventricular tachycardia or ventricular fibrillation.

Ventricular arrhythmias can lead to death. Myocarditis is responsible for sudden cardiovascular death in approximately 5% to 12% of young athletes sudden death [2].

Screening for Myocarditis

Heymans and colleagues outlined a diagnostic algorithm if myocarditis is suspected.[2]

They recommend a biopsy of the heart (endomyocardial biopsy) for those who have manifested life-threatening conditions from myocarditis like:

Mobitz type 2 second-degree or complete heart block
Sustained or symptomatic ventricular tachycardia
Arrythmias that failed to respond to medical management
Those requiring intravenous drugs to support the blood pressure and mechanical ventilator.

If a biopsy is not feasible or if none of the above is not (yet) present, then Cardiac Magnetic Resonance Imaging (MRI) is recommended.[2]

Late Gadolinium Enhancement

Late Gadolinium Enhancement (LGE) is an MRI technique to know the heart muscle’s status. It can detect scars and fibrosis. LGE is also known as “late enhancement” or “delayed enhancement.”

In the article, Cardiac MRI Assessment of Nonischemic Myocardial Inflammation: State of the Art Review and Update on Myocarditis Associated with COVID-19 Vaccination, the authors from the University of Toronto said that LGE imaging is one of the most important MRI techniques in the setting of suspected myocarditis. [3]

They added that the typical cardiac MRI findings reported in patients with myocarditis following COVID-19 vaccination are similar to results in nonvaccine myocarditis.[3] A conclusion shared by another group of radiologists.[6]

This makes the findings of the following authors relevant.

LGE predicts sudden cardiac deaths

Stefan Grün and colleagues conducted a long-term study of 203 patients with viral myocarditis. They found that LGE is a strong, independent predictor of cardiac and all-cause mortality in patients with myocarditis [4]

The presence of late gadolinium enhancement (LGE) yields a hazard ratio of 8.4 for all-cause mortality and 12.8 for cardiac mortality, independent of clinical symptoms.[4]

That means those patients with myocarditis who have LGE on their MRI are 8.4 times more likely to die earlier from any causes. They are also 12.8 times more likely to die from a heart condition regardless of their symptoms.

Asymptomatic myocarditis can also happen, which is why asymptomatic players become symptomatic during a game.

Note: Dr. Cadegiani advanced a hypothesis that myocarditis plus adrenaline surges put a person at risk for sudden death. I discussed that in Myocarditis is more common than Commotio Cardis.

The findings of Grün et al. were also compared and found to be superior to other indicators of lousy myocarditis outcomes.[4]

This (LGE) is superior to parameters like left ventricular ejection fraction, Left ventricular end-diastolic volume, or New York Heart Association (NYHA) functional class, yielding hazard ratios between 1.0 and 3.2 for all-cause mortality and between 1.0 and 2.2 for cardiac mortality.

No patient without LGE experienced Sudden Cardiac Death, even if the left ventricle was enlarged and impaired.[4]

They conclude that the presence of LGE is the best independent predictor of all-cause mortality and cardiac mortality.[4]

If myocarditis is detected, the current recommendation is that individuals who develop myocarditis or pericarditis after a dose of an mRNA vaccine should not receive another dose until additional data are available and to refrain from sports for three to six months, at least. [5]

Sanchez and his group said that no data suggests a role for routine imaging or screening of asymptomatic individuals after COVID-19 vaccination in the absence of signs or symptoms suggestive of myocarditis.

On the other hand, Karl Denninger from The Market Ticker has a different opinion. Karl posted this:

To All NFL Players: READ THIS

Quote:

Spend $1,000 of your own money and no, not any team-approved or affiliated NFL doc either. Pay a qualified independent cardiac specialist.

Go get a troponin test and a cardiac MRI looking specifically for LGE.

If you come positive for damage on either or both go get a lawyer to tell your club to either fork up the entirety of your contract balance, in cash, right now and release you from all further obligation or you’re going to sue the living crap out of both the club and the NFL for coercing you to do what you have every reason to believe caused that condition and which makes you unfit to play.

Full article here.

I ask, why limit to NFL players? Anyone who wants to discover if they are at risk of dying suddenly can do the same.

Suppose a group of employees, soldiers, athletes, nurses, or doctors has LGE on their MRI. In that case, they can consult a cardiologist and see if they need more testing, like an electrophysiologic study, to know if they need to be on medications or have an AICD (Automatic Implantable Cardioverter Defibrillator)implanted.

Next, they can get a lawyer and talk to the people who mandated them to have the shots that caused them to have myocarditis and what they will do about it.

An AICD can immediately convert a deadly ventricular arrhythmia to a normal rhythm. Patients tell me it feels like a horse kicked them, but I guess that’s better than suddenly dying.

Don’t Die Suddenly!

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Related:

References:

Bille K, Figueiras D, Schamasch P, Kappenberger L, Brenner JI, Meijboom FJ, Meijboom EJ. Sudden cardiac death in athletes: the Lausanne Recommendations. Eur J Cardiovasc Prev Rehabil. 2006 Dec;13(6):859-75. doi: 10.1097/01.hjr.0000238397.50341.4a. PMID: 17143117.
Heymans S, Eriksson U, Lehtonen J, Cooper LT Jr. The Quest for New Approaches in Myocarditis and Inflammatory Cardiomyopathy. J Am Coll Cardiol 2016;68(21): 2348– 2364.
Sanchez F.T et al. Cardiac MRI Assessment of Nonischemic Myocardial Inflammation: State of the Art Review and Update on Myocarditis Associated with COVID-19 Vaccination. Radiology: Cardiothoracic Imaging 2021 3:6
Grün S, Schumm J, Greulich S, et al.. Long-term follow-up of biopsy-proven viral myocarditis: predictors of mortality and incomplete recovery. J Am Coll Cardiol 2012;59(18): 1604– 1615.
Luk A, Clarke B, Dahdah N, et al.. Myocarditis and Pericarditis After COVID-19 mRNA Vaccination: Practical Considerations for Care Providers. Can J Cardiol 2021S0828-282X(21) 00624– 3.
Fronza et al. Myocardial Injury Pattern at MRI in COVID-19 Vaccine–Associated Myocarditis. RSNA. Vol.304, No 3. Feb 15, 2022 https://doi.org/10.1148/radiol.212559

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