Better testing could have prevented tragedy

By David Haugh
Updated: January 21, 2010

CHICAGO — Nobody can tell the family or friends of Gaines Adams how to grieve. That’s one of our inalienable rights in life, to react to death or tragedy however we see fit.

So it’s understandable why one of the Adams family’s reactions to his sudden death Sunday from an enlarged heart is to consider legal action, according to sources in South Carolina.

The harder answers are to find, the more we want them.

But after the results of a second autopsy at the family’s request in Greenwood, S.C., confirmed the findings of the first one, no preliminary evidence the Tribune obtained suggests the Bears were negligent.

The coroner’s report could be interpreted, however, as affirmation NFL teams need to continue discussing ways to upgrade the testing of its players’ hearts to prevent the next tragedy.

The autopsy on Adams detected abnormalities in his heart that would have been apparent in an echocardiogram, a source familiar with the results said.

The question isn’t whether NFL teams can afford to require echocardiograms annually for players — a relative pittance at an estimated cost of $180,000 per team. The question may be whether they can afford not to given teams’ access and means to the best in sophisticated health-care prevention.

“I don’t think there’s anybody involved in this that’s concerned about the cost but it’s how do we take this data and turn it into a coherent policy?” said Thom Mayer, the medical director of the NFL Players Association.

“There are two ends of the spectrum. I do think something good will come of this discussion. [Executive director] DeMaurice Smith is absolutely committed to the health and safety of players and we’re supportive of identifying better ways to do that.” That commitment put the echocardiogram issue on the NFL’s radar long before Adams’ death.

“Our medical people, including outside experts who sit on the NFL Cardiovascular Health Committee, have discussed this in the past and have already started to discuss it again pending the final pathologists report on Gaines Adams’ heart,” NFL vice-president of public relations Greg Aiello said in an e-mail.

The typical NFL physical Adams passed after getting traded to the Bears from the Bucs in October only requires an electrocardiography, typically called an EKG.

The difference between the two tests is an EKG measures electrical signals of the heart while an echocardiogram, which costs about $2,500 more, takes a two-dimensional look at the heart and examines chambers, valves and major blood vessels.

It’s more invasive and expensive but more complete.

The Bears performed Adams’ physical in accordance with the Collective Bargaining Agreement, a procedure supported by a recommendation of the American Heart Association on cardiac screenings for elite athletes.

The exam includes a complete medical history, blood and urine tests and an EKG. Based on those results, a decision is made whether to include an echocardiogram.

There was nothing in Adams’ history of exams to suggest he ever needed an echocardiogram, a source said. Adams’ autopsy also showed no evidence of substance abuse after a review of his major organs, a source said.

Toxicology results aren’t due for six weeks but, according to the source, if a drug such as marijuana shows up in Adams’ system it wouldn’t have contributed to the official cause of death.

The coroner’s report indicated that Adams’ heart weighed well beyond 375 grams – which is considered abnormal — and he also suffered from hypertension, a high-blood pressure condition that can lead to hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) afflicts one in 500 Americans and is the leading cause of sudden cardiac death among youths. It is a congenital problem that results in a thickening of the heart muscle, forcing it to work harder until it suddenly stops working altogether.

Interestingly, 55 percent of sudden deaths in athletes related to HCM strike African-Americans, according to a study by the Minneapolis Heart Institute Foundation.

In a league where statistics show 70 percent of its players are black that makes it even more imperative for the NFL to use Adams’ death as the impetus to re-examine matters of the heart.

Not everyone agrees.

Jay H. Alexander, a cardiologist with North Shore Cardiologists who was Mike Ditka’s physician, worried that mandatory echocardiograms could produce too many misdiagnoses.

Alexander wondered how many cases of “Athlete’s Heart Syndrome,” a benign condition in which the heart is enlarged due to exertion, would be confused as HCM and unnecessarily sideline a player.

Enough other liability and privacy concerns exist for Alexander to have doubts.

“The data would suggest to me the cost-benefit ratio is not there to support making ‘echos’ routine,” Alexander said. “I am just not sure you can prevent all the Gaines Adams deaths.” Maybe you can’t. But if you can make a change that prevents even one more, isn’t it worth it?