EXAMINING THE NBA'S ARRHYTHMIAS WITH HEAT CARDIOLOGIST

In the past several months, a startling six NBA players have suffered some form of heart disease. Former Atlanta Hawks center Jason Collier died from cardiac arrest due to an enlarged heart. New York Knicks center Eddy Curry and Los Angeles Clippers center Zeljko Rebraca were diagnosed with irregular heartbeats. Minnesota Timberwolves guard Fred Hoiberg (pictured), Cleveland Cavaliers forward Robert Traylor and Los Angeles Lakers forward Ronny Turiaf underwent open-heart surgeries to fix enlarged aortic roots.

Just a year ago, not a single stethoscope detected a potential problem in any player. Now that six have been sidelined during the season and the All-Star break is still weeks away, that begs the questions: What is going on all of a sudden and will it continue? Well, I spoke with Miami Heat cardiologist, Dr. Edward Neff, to get a first-hand look into the NBA’s heart irregularities and to see how he would handle the future of cardiovascular checkups throughout the league.

Q: Why has there been a recent jump in heart disease throughout the NBA?
A: It’s not entirely clear why that would be this year - the players all had different problems. I just think it’s all fortuitous. There have been really a few significant problems over the years. [Former Boston Celtic great] Reggie Lewis and [former Loyola Marymount University star] Hank Gathers had myocarditis. They shouldn't have been playing - they had infections of their hearts. The guys would be alive today if they didn't play. Those are two guys that if they were treated appropriately, or agreed to be treated appropriately, they wouldn’t have died. They may have gotten better and played again, or maybe not. You can’t blame them because sports was their whole life. More recently, there was a guy by the name of Monty Williams, who played for the Knicks, that I evaluated. He had hypertrophic cardiomyopathy - an abnormally thickened heart muscle. But that was well known to a lot of teams. The Heat turned him down. Philadelphia didn’t want to draft him. New York took a risk and the guy had a 10-year career in the NBA. This year, it was hard to believe that Ronny Turiaf got through the combine. The NBA has the combine every year at Northwestern. They have about 80 players. They all get stress tests and they get examined. Turiaf went through all that stuff and it was sort of missed. He was drafted and no one said anything about it.

Q: In the wake of what’s happened this year, have you noticed that players are more cautious about their cardiovascular health?
A: I don’t think athletes are concerned that much about their hearts. If you had somebody in your family who had hypertrophic cardiomyopathy and died at 26, you might really be interested. But the average person isn’t interested. The players do what they do because the teams say, “This is what you do. You have to go see Dr. Neff.” And then I write a letter and say, “They’re OK to play.” And then they play. They just have to come through me. If they can get away without doing it, they would. Some people are very interested, but I would say the average person isn’t particularly interested. You have to realize that we’re dealing with young, healthy athletes, which is a lot different than dealing with middle-aged and older people who have different outlooks on life. The outlook on life when you’re a young adult is that you’re going to live forever. It’s inconceivable that you’ll get sick, it’s inconceivable that you’ll die. That’s just the way people are. Every once in a while, I’ll find a ballplayer who’s interested in something because his father had it or his grandfather had it. And they say, “I want to check this, I want to check that.”

Q: Before the season, Eddy Curry was traded from the Chicago Bulls to the New York Knicks mainly due to his arrhythmia. Do you think there will be new health clauses added to contracts?
A: The contracts are usually dependent on the player passing the physical. When the Heat got Antoine Walker, he had some sort of orthopedic problem, so the team had to restructure his contract. Let’s say in your contract you can’t ride a motorcycle like with [ex-Chicago Bulls] Jason Williams. He broke his leg from a serious injury riding his bike. In his contract, he wasn’t allowed to ride his motorcycle, so Chicago voided his contract. The Celtics offered to pay Reggie Lewis to retire when he had his heart problem. They said, “Just retire, get a different lawyer and you’ll get your money.” But he didn’t listen to them and he ended up dying. I think the problem is that a lot of athletes aren’t forthright because they’re afraid that their health will interfere with their contract. So a lot of players keep things to themselves. Most people who die from heart disease as athletes have symptoms. It’s very rare for people to have their first symptom as death. Usually people have dizziness, chest pains and unusual shortness of breath that they didn’t experience before. They have had these symptoms before, they ignore the symptoms and then they drop dead.

Q: Which heart disease has the highest death rate among athletes?
A: About 40 percent of sudden deaths in young athletes are from hypertrophic cardiomyopathy. Usually the people who die suddenly usually die through exercise due to hypertrophic cardiomyopathy. And that’s the number one cause of death in young athletes. There’s about six or seven common causes of sudden deaths, such as aneurysms and arrhythmias, but hypertrophic cardiomyopathy is the most common cause. It’s fairly easy to diagnose if the person gets an echocardiogram.

Q: What are some new cardiovascular technologies used for detection?
A: We have echocardiography, cardiac magnetic resonance imaging and cardiac CT angiograms. All these things are noninvasive ways to make all the diagnoses you usually make. It’s not a mystery how you make the diagnosis. If the person gets tested, they have screenings because there’s a lot more risk. It makes sense before you sign a guy to a 100-million-dollar contract that you certainly want to make sure you’re going to get your 100-million dollars worth.

Q: Doctors said that Curry’s massive size (6-11, 285 lbs) was one of the reasons he suffered from arrhythmia. How does height and weight play a factor?
A: If you’re growing too fast, it’s not good for you. But I don’t think that height and weight play a role unless you have Marfan's syndrome. Flo Hyman was an All-American volleyball player who played on the Olympic team [in 1984] and she dropped dead in competition because she had Marfan’s. It’s a disease when the connective tissue that holds everything together is very weak. People can get a dissection, or a tear, of the aorta and they can die, so we have to replace the aortic root like with Ronny Turiaf. Their aortic valves can deteriorate and they can get aortic aneurysms. These people can have sudden death. I don’t think there’s any more heart disease in anyone else, other than in usually tall, skinny people who can get Marfan's syndrome. They have a high-arched palette, they have long, spider-like fingers and they get ectopic lenses - the lenses in their eyes can dislocate. They also have excessively long legs. These people, if they’re lucky, can have their aorta replaced like Ronny Turiaf or it will fall apart.

Q: It has been reported that Fred Hoiberg will play this season with a pacemaker. What are your thoughts on that?
A: Pacemakers are very sophisticated. They can be very responsive now depending on what Hoiberg’s problem is. If his upper chamber, or the atrium - which is where your heart beats faster and pumps more blood when you do activity - is working fine and he just has a block between the upper and lower chamber, they can program the pacemaker so that he can have a normal cardiac output. If he doesn’t have that and it’s another problem, then they have rate-responsive pacemakers depending on how much activity he’s doing. You have accelermometers - they’re either heat-related, related to how much you’re breathing or how much you’re jumping up and down. The pacemaker increases its rate according to what the activity is. So Hoiberg could go back and play. The question is: Will he have enough cardiac output to be an elite athlete? And the answer is no. I don’t know if anybody has ever played with a pacemaker before - I’m sure they played pick-up. Yes, he can play with a pacemaker, but the real questions are: What is his problem? What kind of pacemaker does he have? What’s his electrical problem? And can he achieve enough cardiac output to play competitive athletics?

Q: What is your role with the Heat?
A: What I do with the Heat is that I check everybody once a year before the season starts. When the Heat brings in people for tryouts before the season, including anybody that doesn’t go to the combine, we give them physical examinations and echocardiograms before the team works them out. We don’t want to miss hypertrophic cardiomyopathy and other problems. We do a full physical examination every year. Plus, we do an ultrasound of the heart and we do an exercise stress test on every player annually.

Q: If the NBA consulted you to help prevent these heart problems from recurring, what would you recommend?
A: I think the NBA is going to come out now with new guidelines. See, right now it’s up to the team. The Heat does everything on every player every year; whereas, there are some teams who cheap out and don’t do everything on every player. They don’t do much of an exam or they have their orthopedic guy exam them. If you have an orthopedist exam the patients, they’re going to be looking at their joints, but not really looking for cardiovascular disease. That’s the problem in the NBA now. Whereas in the Women’s Tennis Association, all the players who have played competitive tennis professionally have to get one physical examination in the first year that they play. One year when I went to the Lipton [now called the Nasdaq-100 Open], I examined the players because everybody had to get it done that year. But that’s the WTA’s standard for physical examinations. As far as the NBA goes, up until now the teams can do whatever they want. There is no NBA guideline for how they examine their players. I think what you’re going to see coming up after the All-Star game are certain guidelines for physical examinations. You’re also going to see guidelines for trainers to use automatic defibrillators.

Q: There was already some resentment from the players over the new dress code. What difficulties face the league in requiring each team to comply with mandatory medical tests?
A: You can only go so far. I mean, you can’t get everybody to do every test on every person. It becomes extremely expensive and you find a lot of information that you have difficulty understanding. But by doing regular history and physical examinations, routine studies, stress tests and echo’s, you can pretty much get a clue most of the time. The number one cause of death in young athletes - hypertrophic cardiomyopathy - is easy to pick up. That you can get on an echocardiogram. You can see an abnormality in the way the electricity goes through the heart. You can see if their aortas are enlarged and if they have an increased risk in sudden death. If they have Marfan's syndrome, maybe you can pick it up on the physical examination. One thing that may not be easy to pick up is congenital anomalous arteries like with Pistol Pete Maravich. He had a left coronary artery coming off the right coronary side. It came from the wrong side, went behind the heart in-between the aorta and the pulmonary artery and got squished. The guy played a whole NBA career and then died playing pick-up basketball. It’s bizarre, but that’s what happens. You can detect it by doing an angiogram or doing a coronary CAT scan, but you have to have some sort of inkling.