On Thursday, Kansas City Chiefs defensive end BJ Thompson suffered a seizure and then went into cardiac arrest at the team's practice facility. Thompson, 25, was transported to the hospital by ambulance and was reported to be in stable condition. The Chiefs sent players home and rescheduled their offseason practices.
It's one of several recent heart-related events for prominent athletes.
In December 2023, Luton Town captain Tom Lockyer suffered cardiac arrest on the pitch during his team's match at Bournemouth. On July 24, 2023, then-18-year-old USC freshman guard Bronny James, son of Los Angeles Lakers star LeBron James, went into cardiac arrest during a practice at USC. In January 2023, Buffalo Bills safety Damar Hamlin, then 24 years old, suffered cardiac arrest during a game against the Cincinnati Bengals. In June 2022, then-USC freshman center Vince Iwuchukwu, then 19 years old, suffered cardiac arrest during practice. In June 2021, Danish midfielder Christian Eriksen, then 29 years old, suffered cardiac arrest on the field during a Euro 2020 match.
In all six cases, the athletes received immediate care from trained specialists and survived. In May, Lockyer, who was fitted with a defibrillator after his December incident, said that he hopes to return to the court but that he is also “at peace” with the prospect of retiring. James, Hamlin, Iwuchukwu and Eriksen were cleared to return to play, and on December 10, 2023, James made his season debut for USC in an 84-79 overtime loss against Long Beach State, scoring 4 points in 17 . Minutes of action from the bench.
Each situation attracted international headlines and raised questions in and around the medical and sports communities about heart problems among young, apparently healthy athletes. Leading specialists have commissioned studies and cardiologists across the country have sought to address concerned parents, especially in the age of conspiracy theories and misinformation.
Today, after a years-long pandemic and several rounds of new vaccines and boosters, cardiologists regularly face questions about how COVID-19 and its vaccines impact heart health.
“We are not seeing a sign that before and after COVID [cardiac] “Sports events are different,” said Dr. Matthew Martinez, director of the sports cardiology and hypertrophic cardiomyopathy center at Morristown Medical Center in New Jersey, and a consulting cardiologist for the National Basketball Players Association.
“What we are seeing, however, is that more and more people are being evaluated as a result of COVID. So we are making the diagnosis of underlying congenital heart disease in those who did not know it. [they had it], such as hypertrophic cardiomyopathy, more frequently than before. And because of the fear of COVID myocarditis, more and more parents and more athletes are saying, 'Hey, I have these symptoms and I'm worried,' and they're seeking medical attention.”
Myocarditis is inflammation of the heart muscle and can be found or develop from viral infections or sometimes autoimmune diseases. “These inflammatory mediators get trapped inside the heart muscle and can cause the heart muscles to slow down,” said Dr. David J. Engel, director of the sports cardiology program at NewYork-Presbyterian/Columbia University Irving Medical Center. . “And so the heart's pumping power decreases, and people can get very sick.”
Hypertrophic cardiomyopathy is an increase in the thickness of the heart muscles and, according to Martinez, is a common genetic heart disease found in about one in 500 people worldwide, according to a 2015 study published in the Journal of the American College of Cardiology. “Most of them live normal lives and die from another cause,” said Dr. Steve Ommen, a cardiologist and medical director of the hypertrophic cardiomyopathy clinic at Mayo Clinic in Rochester, Minnesota.
However, according to Martínez, it is one of the known causes of cardiac arrest.
Sudden cardiac arrest occurs when the heart beats one minute and doesn't beat the next, Martinez said, and the only way to get it pumping again is to use an automated external defibrillator (AED), which sends an electrical shock to the heart. . (Cardiac arrest is different from a heart attack, which occurs when the arteries in the heart become blocked and blood flow to the heart muscle is reduced, causing damage to the heart muscle. If that damage is extensive, it can cause cardiac arrest. )
“It's not someone who is in the hospital with symptoms of chest pain for the last three days or heart failure for the last few weeks, and they get worse and worse and then they die,” Ommen said. “This takes 24 hours from the first symptom to death. And it's usually caused by electrical irregularities in the heart, which make the heart ineffective in the way it pumps.”
However, in many cases the cause of cardiac arrest is unknown.
In an effort to better understand the state of heart health among athletes, ESPN interviewed four prominent cardiologists, several of whom work with professional and collegiate athletes, and examined recent peer-reviewed studies that the cardiologists cited as critical to these topics.
Are athletes at higher risk for heart problems?
“That the general population? No,” said Dr. Thomas McGarry, a clinical and interventional cardiologist at Oklahoma Heart Hospital Physicians. “But there are certain athletes who are at risk.”
McGarry cites a 2023 study of 76 professional and NCAA athletes who had genetic heart disease and were allowed to return to play. “And of those 76 individuals, three people had problems, but they all survived because the institutions and/or teams knew what was happening and were able to treat them very quickly with external defibrillators,” she said.
Ommen also notes that athletes are generally not at risk for further heart-related problems. “For recreational athletes, the answer is undoubtedly no,” she said. “For those of us who are not professional athletes, more exercise is always better. There are rare conditions like exercise-induced atrial fibrillation, which is an abnormal heart rhythm caused by exercise. So there are some people who we have “In recent years there have been people identified who have had that on professional sports teams and generally they have received treatment and returned to action, but that is rare.”
Martinez said the same thing. “Exercise is medicine. Exercise is our best blood pressure control, it's our best cholesterol control, it's our best mental health control and it relieves stress,” he said. “For people under 40 years old, heart-related cardiac risk is usually a congenital problem. But for people over 40 years old, it is an acquired heart arterial disease. [heart attacks]. In this group, the best way to prevent sudden cardiac death in that group is with exercise. So exercise does not promote risk; reduces the risk.”
Can a player with myocarditis or hypertrophic cardiomyopathy continue to play?
It depends.
With myocarditis, “you have to stop someone and let the heart muscle heal,” Martinez said. “And then once that muscle has healed, an expert will perform a risk stratification evaluation (an evaluation to determine, in part, the risk of suffering a cardiac event) to see if they are truly back to that minimal risk level. they had before myocarditis and we are going to do the same with hypertrophic cardiomyopathy.
Other cardiologists echoed this point. Engel cites guidelines from the American Heart Association and the American College of Cardiology that a player with active myocarditis should refrain from exercise for three to six months and then be reevaluated before returning to play.
“Almost always, once the inflammation goes down, the heart muscle is in good condition,” Engel said. “And if the markers of active inflammation are no longer present, then the athlete can return to play.”
Martínez cites the aforementioned 2023 study, which he authored, which examined 76 athletes suffering from genetic heart disease. This shows that “having underlying heart disease is not an automatic disqualification, that an athlete with myocarditis or hypertrophic cardiomyopathy can continue to play after careful review,” he said.
What links, if any, exist between the COVID-19 virus and heart problems?
According to each cardiologist, the most common link, especially in earlier variants of COVID-19, is myocarditis. That COVID-19 could cause myocarditis was not unexpected, they say, since myocarditis can often be caused by viral infections.
“Viruses have caused myocarditis for as long as we've known anything about viruses, and the COVID virus is no different,” Martinez said. “COVID is one of the viruses that can cause myocarditis. There was myocarditis before COVID, there will be myocarditis after COVID.”
A 2021 study published in JAMA Cardiology, which Martinez helped write, examined 789 professional athletes with COVID-19 infection who underwent post-COVID cardiac testing as recommended by the American College of Cardiology. In that group, the prevalence of myocarditis was low: around 0.6%.
In an April 2021 national study published in the American Heart Association journal Circulation that examined 3,018 college athletes who had tested positive for COVID-19 and had undergone cardiac evaluation, heart problems were found in 21 (or 0.7%) of those athletes.
“It's not a strong bond,” Engel said.
What links, if any, exist between the COVID-19 vaccine and heart problems?
All four cardiologists say heart problems are more likely to arise from the COVID-19 viral infection than from vaccines. Citing a 2023 peer-reviewed study in the international scientific journal Biomedicines, Martínez and Engel note that the rate of someone who receives a COVID-19 vaccine and later has myocarditis is 30 out of 100,000, or 0.03%.
“Concern about myocarditis should not be a justification for not receiving the vaccine, because the incidence of myocarditis after the COVID vaccine is exceptionally low,” Engel said.
