Wonderful conversation! I was on the edge of my seat the whole time. It is such a pleasure to have world renowned cardiologists in my own living room. I like the idea of much more widespread availability and training of AEDs. Thank you John Mandrola!
Didn’t Hamlin receive 9 minutes of cpr, pronounced dead at the scene? I’m pretty damn sure if Hamlin is alive he is not a thinking person after that.🤷♀️
I was a nurse at Stanford for 33 years...was in CCU and was completely puzzled by a rhythm I could not diagnose. Dr. Winkle happened by, took a look and said, "Trust me; it's____." (Can't remember.) Even after he explained it, I couldn't see it; from that moment on, I referred to the rhythm as "Winklebach".
I was a nurse at Stanford for 33 years...was in CCU and was completely puzzled by a rhythm I could not diagnose. Dr. Winkle happened by, took a look and said, "Trust me; it's____." (Can't remember.) Even after he explained it, I couldn't see it; from that moment on, I referred to the rhythm "Winklebach".
Love your podcasts and have never left a comment before but today I was so disappointed with you. An entire hour and no mention of the damage the COVID vaccines have had on heart health. So disingenuous...I expected a more balanced approach from you. If you do not believe they had any impact, then say so, but to say nothing was lame.
I am an ICU nurse and have been for the last 29 years. I’ve seen more young people having arrhythmias and heart problems like myocarditis than I’ve ever seen in my 29 years as an ICU nurse. Thanks for addressing the elephant in the room. Not.
I was listening with a question that didn’t really get answered. It’s this:
I understand why screening all athletes doesn’t make sense but is there a specific list of boxes that get ticked which do trigger additional screening? What about the test you mentioned that professional athletes get? What determines if/when other athletes should get that?
In the sports physical, a pediatrician listens to their heart and asks about family history. That’s it. New this year she did ask if anyone in our family died suddenly. What I wonder is, is that thorough enough???
I sort of suspect they are disincentivized to discover exploding rates of myocarditis, so I wonder if as parents we should be doing anything further to protect our kids? Should we be on the look out for specific things(?) For example, severe cramping. Or getting super pale. Are there warning signs of things that happen to people during exercise that are precursors or indications?
Ok, don’t screen everybody. But who for sure should get additional testing?
John, Love your stuff. But many of us will never get to hear this. We are hearing impaired, visual learners, or just do not have an hour to invest in the literally 50 one hour listening invites we get each day.
Luckily, autotranscribers are free/cheap and surprisingly effective. (Not perfect, but neither is listening.) As many other stacks have done effectively, there are many of us who hope that you can transcribe these podcasts and post the transcription with the recording. It will substantially enlarge your engaged readership which has to be high on your hit parade.
Many thanks. Soon I will start begging, but the message will be the same.
Very interesting and useful discussion of this issue. Dr. Dorian exhibits an absolute honesty that we should expect from researchers and investigators. The bottom line is that we don't know much of anything for sure in this area and screening won't really help. I think you and Dr. Dorian hit it out of the park when you concluded that the best available solution is greater availability of defibrillators. In southern California most schools demanded "medical clearance" from a physician before the student could compete in sports. Early in my career I did this for children or grandchildren of some of my patients. The only thing we looked out for was undiagnosed aortic stenosis and/or IHSS.
I was interested in the discussion of hypertrophic right ventricular disease. Is that a response to pulmonary hypertension or a disorder unto itself?
While your intended audience may be those in your field, I listened because my son plays 3 sports. Also because our School Board mandated the CoVid vaccine in order to attend school. It was painful watching high school boys run up and down the basketball court masked and vaxxed. Now that our School Board has played Doctor, I’ve been concerned that we may have a situation or, a situation waiting to happen. After listening, I want to go to our School Board and suggest the thing you propose at the end. Unfortunately, I’m not exactly popular here. I’m that mom who stood out on the corner passing out flyers (with accurate information) and organized a protest. They don’t appreciate hearing from me. But what to do? This made so much sense to me; why screening doesn’t work and why having a defibrillator on hand at each sporting event is a good idea. When you look at the statistic about how many people need to be vaccinated in order to save one life, it’s some enormous number and it’s accepted as something we do. For better or worse, I’m encouraged by this podcast to suggest this to our School Board. I’m going to take a tip from you and not mention the elephant in the room. I noticed you didn’t mention the rising rates. Is that also taboo to acknowledge?
Not mentioning the COVID issues is highly problematic, John. You and your interview sound like you're covering, basically like how it's been framed by all the powerful forces trying to downplay the issue. Oh, it's "rare." Oh, it's "highly publicized."
You know what's not publicized? People's arrhythmias due to the spike protein/vaccines. By saying it's "highly publicized" you downplay the issue significantly.
Early on Paul correctly states that sudden cardiac arrest (SCA) in young competitive athletes is rare (and the availability heuristic/bias) and gives some statistics around the prevalence (probability) of SCA annually. He gives a figure of 1 in 200,000 athletes.
Based on higher-quality studies/data, we estimated the prevalence in young competitive athletes as:
SCD - 1.91 (95% CI = 0.71, 5.14) per 100 ,000 athlete years. This means we if we watched 100,000 athletes under the age of 40 over a one year period we would expect to see around between 2 (with a range between 1 and 5) sudden cardiac deaths. These data are a pooled meta-analysis of data from 3 studies we judged to be at low risk of bias and therefore provide the most reliable estimates.
SCA - between 0.94 (95% CI = 0.55, 1.62) and 1.58 (95% CI = 1.39, 1.79) SCA events per 100,000 athlete years from two separate studies we judged to be low risk of bias.
We identified only 4 published accounts (3 full papers and 1 conference abstract) of nonrandomized studies reporting this intervention. Pooled data from 2 studies (n = 3 869 274; very low-quality evidence) showed an inconclusive 42% relative decrease in risk of sudden cardiac death (relative risk = 0.58; 95% CI = 0.23, 1.45), equating to an absolute risk reduction of 0.0016%. The findings were consistent with a potential 77% relative decreased risk to a 45% relative increased risk in participants screened using ECG. The evidence was of low quality meaning we were very uncertain about the findings.
This is the most up-to-date evidence we have for estimates of the prevalence of SCD and SCA in young athletes as well as the effectiveness of ECG screening in this group. It can also be useful to answer some of the comments from other in relation to "the elephant in the room"
For example, using the estimates from our prevalence study we can determine the numbers of events we might expect to see if we were to watch/follow all individuals between the age of 15 and 35 in America - this number is roughly 88.5 million. Let's assume they are ALL competitive athletes - we can apply our prevalence estimates to them as follows:
Sudden cardiac death: if we watched 100,000 = ~2 events per year. If we watch 88.5 million = ~1690 events per year (based on [88500000 / 100000] x 1.91), with a range between 628 to 4549.
Sudden cardiac arrest: 832 to 1398 (range between 486 and 1575) per year.
Remember - all the above estimates are based on assuming ALL 88.5 million 15 to 35 year olds are competitive athletes. If we assume 5% to 10% of this age group are competitive athletes, the numbers look like:
An important reminder is that extraordinary claims require extraordinary evidence. Hopefully we can see here how an evidence-based approach can help us determine when such claims hold.
Wonderful conversation! I was on the edge of my seat the whole time. It is such a pleasure to have world renowned cardiologists in my own living room. I like the idea of much more widespread availability and training of AEDs. Thank you John Mandrola!
https://www.mensjournal.com/pursuits/cycling/pro-cyclist-retires-due-to-cardiac-issues
https://youtu.be/VH30GIjb3cg?si=-gEgeB7a76l4if7o
How about have cardiologist Steven Lome, D.O., run every marathon? :)
https://www.runnersworld.com/news/a42039130/cardiologist-rescusciates-two-fellow-runners-at-monterey-bay-half-marathon/
Didn’t Hamlin receive 9 minutes of cpr, pronounced dead at the scene? I’m pretty damn sure if Hamlin is alive he is not a thinking person after that.🤷♀️
I was a nurse at Stanford for 33 years...was in CCU and was completely puzzled by a rhythm I could not diagnose. Dr. Winkle happened by, took a look and said, "Trust me; it's____." (Can't remember.) Even after he explained it, I couldn't see it; from that moment on, I referred to the rhythm as "Winklebach".
I was a nurse at Stanford for 33 years...was in CCU and was completely puzzled by a rhythm I could not diagnose. Dr. Winkle happened by, took a look and said, "Trust me; it's____." (Can't remember.) Even after he explained it, I couldn't see it; from that moment on, I referred to the rhythm "Winklebach".
Love your podcasts and have never left a comment before but today I was so disappointed with you. An entire hour and no mention of the damage the COVID vaccines have had on heart health. So disingenuous...I expected a more balanced approach from you. If you do not believe they had any impact, then say so, but to say nothing was lame.
I am an ICU nurse and have been for the last 29 years. I’ve seen more young people having arrhythmias and heart problems like myocarditis than I’ve ever seen in my 29 years as an ICU nurse. Thanks for addressing the elephant in the room. Not.
I was listening with a question that didn’t really get answered. It’s this:
I understand why screening all athletes doesn’t make sense but is there a specific list of boxes that get ticked which do trigger additional screening? What about the test you mentioned that professional athletes get? What determines if/when other athletes should get that?
In the sports physical, a pediatrician listens to their heart and asks about family history. That’s it. New this year she did ask if anyone in our family died suddenly. What I wonder is, is that thorough enough???
I sort of suspect they are disincentivized to discover exploding rates of myocarditis, so I wonder if as parents we should be doing anything further to protect our kids? Should we be on the look out for specific things(?) For example, severe cramping. Or getting super pale. Are there warning signs of things that happen to people during exercise that are precursors or indications?
Ok, don’t screen everybody. But who for sure should get additional testing?
John, Love your stuff. But many of us will never get to hear this. We are hearing impaired, visual learners, or just do not have an hour to invest in the literally 50 one hour listening invites we get each day.
Luckily, autotranscribers are free/cheap and surprisingly effective. (Not perfect, but neither is listening.) As many other stacks have done effectively, there are many of us who hope that you can transcribe these podcasts and post the transcription with the recording. It will substantially enlarge your engaged readership which has to be high on your hit parade.
Many thanks. Soon I will start begging, but the message will be the same.
Very interesting and useful discussion of this issue. Dr. Dorian exhibits an absolute honesty that we should expect from researchers and investigators. The bottom line is that we don't know much of anything for sure in this area and screening won't really help. I think you and Dr. Dorian hit it out of the park when you concluded that the best available solution is greater availability of defibrillators. In southern California most schools demanded "medical clearance" from a physician before the student could compete in sports. Early in my career I did this for children or grandchildren of some of my patients. The only thing we looked out for was undiagnosed aortic stenosis and/or IHSS.
I was interested in the discussion of hypertrophic right ventricular disease. Is that a response to pulmonary hypertension or a disorder unto itself?
While your intended audience may be those in your field, I listened because my son plays 3 sports. Also because our School Board mandated the CoVid vaccine in order to attend school. It was painful watching high school boys run up and down the basketball court masked and vaxxed. Now that our School Board has played Doctor, I’ve been concerned that we may have a situation or, a situation waiting to happen. After listening, I want to go to our School Board and suggest the thing you propose at the end. Unfortunately, I’m not exactly popular here. I’m that mom who stood out on the corner passing out flyers (with accurate information) and organized a protest. They don’t appreciate hearing from me. But what to do? This made so much sense to me; why screening doesn’t work and why having a defibrillator on hand at each sporting event is a good idea. When you look at the statistic about how many people need to be vaccinated in order to save one life, it’s some enormous number and it’s accepted as something we do. For better or worse, I’m encouraged by this podcast to suggest this to our School Board. I’m going to take a tip from you and not mention the elephant in the room. I noticed you didn’t mention the rising rates. Is that also taboo to acknowledge?
Not mentioning the COVID issues is highly problematic, John. You and your interview sound like you're covering, basically like how it's been framed by all the powerful forces trying to downplay the issue. Oh, it's "rare." Oh, it's "highly publicized."
You know what's not publicized? People's arrhythmias due to the spike protein/vaccines. By saying it's "highly publicized" you downplay the issue significantly.
Come on man. Grow a spine.
Fantastic discussion
I enjoyed the discussion John and Paul.
Early on Paul correctly states that sudden cardiac arrest (SCA) in young competitive athletes is rare (and the availability heuristic/bias) and gives some statistics around the prevalence (probability) of SCA annually. He gives a figure of 1 in 200,000 athletes.
Readers/listeners might be interested in a systematic review we published in 2022 which aimed to collate the best available evidence on the prevalence of SCA and sudden cardiac death (SCD) in young (<40 years of age) competitive athletes (and military personnel): https://meridian.allenpress.com/jat/article/57/5/431/465811/Incidence-of-Sudden-Cardiac-Arrest-and-Death-in
Based on higher-quality studies/data, we estimated the prevalence in young competitive athletes as:
SCD - 1.91 (95% CI = 0.71, 5.14) per 100 ,000 athlete years. This means we if we watched 100,000 athletes under the age of 40 over a one year period we would expect to see around between 2 (with a range between 1 and 5) sudden cardiac deaths. These data are a pooled meta-analysis of data from 3 studies we judged to be at low risk of bias and therefore provide the most reliable estimates.
SCA - between 0.94 (95% CI = 0.55, 1.62) and 1.58 (95% CI = 1.39, 1.79) SCA events per 100,000 athlete years from two separate studies we judged to be low risk of bias.
I also wrote a blog highlighting our findings in relation to the Eriksen case at the time: https://www.phc.ox.ac.uk/news/blog/can-science-help-us-avoid-another-christian-eriksen-it2019s-not-as-simple-as-you-might-think. Here I also give some perspective whereby we would expect between 50 to 100 cases of sudden cardiac death per 100,000 people in the general population over one year.
We also concurrently performed a systematic review assessing the best available evidence for the effectiveness of electrocardiogram screening in young athletes: https://meridian.allenpress.com/jat/article/57/5/444/465814/Screening-Electrocardiogram-in-Young-Athletes-and
We identified only 4 published accounts (3 full papers and 1 conference abstract) of nonrandomized studies reporting this intervention. Pooled data from 2 studies (n = 3 869 274; very low-quality evidence) showed an inconclusive 42% relative decrease in risk of sudden cardiac death (relative risk = 0.58; 95% CI = 0.23, 1.45), equating to an absolute risk reduction of 0.0016%. The findings were consistent with a potential 77% relative decreased risk to a 45% relative increased risk in participants screened using ECG. The evidence was of low quality meaning we were very uncertain about the findings.
This is the most up-to-date evidence we have for estimates of the prevalence of SCD and SCA in young athletes as well as the effectiveness of ECG screening in this group. It can also be useful to answer some of the comments from other in relation to "the elephant in the room"
For example, using the estimates from our prevalence study we can determine the numbers of events we might expect to see if we were to watch/follow all individuals between the age of 15 and 35 in America - this number is roughly 88.5 million. Let's assume they are ALL competitive athletes - we can apply our prevalence estimates to them as follows:
Sudden cardiac death: if we watched 100,000 = ~2 events per year. If we watch 88.5 million = ~1690 events per year (based on [88500000 / 100000] x 1.91), with a range between 628 to 4549.
Sudden cardiac arrest: 832 to 1398 (range between 486 and 1575) per year.
Remember - all the above estimates are based on assuming ALL 88.5 million 15 to 35 year olds are competitive athletes. If we assume 5% to 10% of this age group are competitive athletes, the numbers look like:
Sudden cardiac death:
5% = 85 (range between 31 and 227) per year
10% = 170 (63 and 455)
Sudden cardiac arrest:
5% = 31 to 70 (24 and 79) per year
10% = 83 to 140 (49 and 158)
It may well be that availability bias (https://www.techtarget.com/whatis/definition/availability-bias) is driving much of the discussion about "elephants".
An important reminder is that extraordinary claims require extraordinary evidence. Hopefully we can see here how an evidence-based approach can help us determine when such claims hold.