Sports Cardiology: Awareness of This Growing, Vital Field is Spiking

There is little doubt that sports cardiology, a field well-represented at Baptist Health Miami Cardiac & Vascular Institute, is rapidly advancing in awareness and practice across the nation and globally. Look no further than the most recent World Cup soccer competition, which included at least two standout players fitted with implantable cardioverter defibrillators (ICDs), which can reset the heart after sudden cardiac arrest.

Eli Friedman, M.D., medical director of sports cardiology at Baptist Health Miami Cardiac & Vascular Institute.

In the U.S., well-known professional basketball, football and baseball players are competing with heart conditions requiring close monitoring. Most strikingly, the field of sport cardiology gain worldwide attention on Jan. 2 in Cincinnati when Buffalo Bills defensive back Damar Hamlin, 24, suffered sudden cardiac arrest after a tackle and was revived after extensive CPR and the use of an AED (Automated External Defibrillator), a device that delivers an electric shock to restore normal heart rhythm.

Although rare, such incidents among pro players across all sports shine the spotlight on this medical field, which applies as much to the amateur athlete at any age – the most active among us who are committed to running, cycling or other physically challenging and recurring activity.

The growth and continuous challenges of this specialty are well known to Eli Friedman, M.D., medical director of sports cardiology at Baptist Health Miami Cardiac & Vascular Institute, which is spearheading programs to help diagnose or treat cardiovascular conditions in athletes – and active individuals at all ages -- across South Florida, and help train athletes and their coaches in proper CPR techniques in school and college athletic programs.

Dr. Friedman is well known in the field for promoting well-rehearsed “emergency action plans” (EAP), which he highly recommends for every organization, school or institution that sponsors athletic activity. EAPs include extensive training in CPR and the application of AEDs.

Sports cardiology at the professional level helps bring attention to the needs of the amateur athlete, or anyone who may have underlying health issues or other predisposition for cardiovascular issues, which could become life-threatening if left untreated.

“It’s not the professional athletes who take up the bulk of our time in the office,” explains Dr. Friedman. “It's actually the 55-year-old, for example, who's been running forever and now has atrial fibrillation (a common irregular heartbeat) or coronary disease or hypertension or whatever it is. And this active person wants to continue to train and do those sorts of things. But the awareness of sports cardiology is coming more from the professional level and how more teams are meeting the challenges of their athletes.”

Dr. Friedman emphasizes that the advancement of sports cardiology among professional teams has been significant in just the last couple of years. This medical field brings together experts from cardiology and sports medicine to diagnose and treat any known or unknown heart conditions. The pros don’t just focus on orthopedic care to prevent or treat injuries.

“We’re seeing a real shifting of the culture very rapidly -- more toward the importance of the sports cardiologist to the athletic healthcare team,” said Dr. Friedman. “It used to be just the orthopedic surgeon, and then the primary care sports medicine physician came in. And now the cardiologist is really playing an integral role. You’re seeing more people playing very elite and competitive sports with heart conditions. And you're seeing the cardiologist really become a very strong, impactful member of the healthcare team for the athlete.”

In an article published by the American College of Cardiology, Dr. Friedman states that “CPR and AED training should be continually reinforced and offered to all members of a sporting organization (not just EAP stakeholders), and the EAP should be rehearsed and edited at least once per year. These fundamental efforts form the foundation for which lives can be saved should medical emergencies arise.”

Here are examples of star athletes with heart issues:

• Denmark’s soccer star midfielder Christian Eriksen, 30, took part in the World Cup last year fitted with an ICD, which can reset the heart after a cardiac arrest. In June 2021, he suddenly collapsed during a match and was revived after being given CPR -- and an Automated External Defibrillator (AED) was used to reset his heart so it could pump blood properly again. Netherlands defender Daily Blind, 32, is also fitted with an ICD and played in the World Cup as well.
  
  
• Jared Butler, 22, of the NBA’s Utah Jazz, has a condition called hypertrophic cardiomyopathy (HCM), a congenital disorder condition in which the heart muscle becomes abnormally thick. HCM makes it hard for the heart to pump blood. He is asymptomatic and has been cleared to play basketball, but his condition is closely monitored by his doctor.
  
  
• J.J. Watt, 33, a longtime standout defensive end for the NFL’s Arizona Cardinals, had his heart shocked back into rhythm in September after experiencing atrial fibrillation, the most common type of treated heart arrhythmia, or irregular heartbeat. Watt played again days later.

The sports cardiology program at the Institute includes cardiologists, physical therapists, imaging technologists and nutritionists. Each new patient starts with a physical exam and consultation, including a discussion about any symptoms you have and the details of the patient’s active lifestyle, along with a review of personal or family history of heart disease. Testing may include cardiopulmonary stress testing; electrocardiograms (ECG); blood tests; electrophysiology studies; echocardiogram; cardiac MRI or CT coronary angiography.

Yet, even with the most thorough screening modalities, sudden cardiac arrest can occur, particularly in the young professional athlete, said Dr. Friedman.

“The number one cause of sudden death in sport is sudden unexplained death, meaning that all testing that may have been done previously were normal. Yet, the bad things still happen,” he explains. “So, awareness is key. Having emergency action plans are the best way to do this with the professional organizations, the national governing bodies demonstrating that they are preparing for this. And then demonstrating that CPR and AED awareness is the way to go, because no screening modality is 100 percent, and we need to be prepared.”

Who Benefits from Sports Cardiology?

The Institute treat all types of athletes and active individuals. You may benefit from sports cardiology if you:

• Have a personal or family history of heart disease and want to safely participate in sports and strenuous activities.
• Have heart symptoms — such as chest pain, fainting or heart palpitations — that affect your ability to be active or play sports.
• Need a recovery plan for safely returning to work, activities or sports after heart surgery or a heart attack.

Here’s more information on the Institute’s sports cardiology program.