The Editor, Sir:

In an article entitled 'The athlete and sudden death' published in The Gleaner on December 5, Dr William A. A. Foster, professor of medicine at the University of the West Indies wrote that "A sunset, purple in majesty or clothed in amber streaks, may take your breath away. Heavy clouds, pregnant with a simmering illness may also take your breath away, albeit prematurely. Today, you have the opportunity to choose."

The point being made by Foster is that technology and medicine now have the wherewithal to decipher between those who are at risk of sudden death from exertion and healthy individuals who can stress their bodies to extremes without being subjected to harmful consequences.

Perhaps you have heard that the breakfast of champions is aspirins so they can cope with the aches and pains of stressing their bodies. On the other hand, there are too many sad stories of sudden death in athletes, eg the captain of the USA volleyball team in the 1984 Olympics, Flo Hyman; or a 32-year-old basketball player, Pete Maravich, an NBA legend.

These cases grab our attention and suggest that the deaths may be avoided by doing a thorough history and physical examination and some simple non-invasive tests. This is the central point of Dr Foster's article.

MISCONCEPTION

Exercise, track and field, football, basketball and sports in general are of great public interest in Jamaica where we have an excellent sports tradition and our athletes are world-class. The perception is that our athletes are physically fit and the picture of health.

This misconception has fuelled a carefree attitude to the health of athletes and unfortunately diseases of athletes have received scant attention.

The cases of Matthew Hilton (18 years old ), swimmer of Ardenne High School and Terrence Golding (17 years old) footballer from Eltham High School, brought home to all of us that sudden death of young athletes during competition is tragic but probably avoidable with proper screening.

It is, therefore, our duty and responsibility to determine, with a reasonable degree of reliability, whether students who are participating in sports are free from cardiovascular abnormalities that could increase the risk of death during athletic training and competition. It is shocking when a young, gifted college student who is asymptomatic, dies suddenly during com-petition. These deaths are not flukes.

Just as strokes are the result of uncontrolled high blood pressure, many causes of sudden death in athletes can now be identified and effectively addressed. Because of this advancement in medicine, there now seems to be a spirit of collaboration between physicians, coaches, institutions of higher learning and sports organisations to use the clinical and technological advances in medicine for the screening and identification of individuals at risk.

The result of these screening examinations may establish the criteria for eligibility and disqualification from competitive sports.

Devastating conditions

By doing so, we are able to prevent these devastating conditions from destroying hearts too young to die. For most students, participation in sports has physical, financial and social benefits, but for some, the consequence is death. High schools and universities must use reasonable medical care in conducting their athletic programmes.

Screening all competitive athletes reduces exercise-related acute cardiovascular events in a cost-effective way. For less than US$300 per student, they can be assured that a reliable cardio-vascular evaluation has been done to exclude major known causes of sudden death and that they have been cleared for participation in athletic training and competition or be advised otherwise. Doing so reduces exercise-related acute cardio-vascular events/death in a cost-effective way.

I am, etc.,

Dr B. Waine Kong

wkong@caribbeanheart.com

Heart Institute of the

Caribbean Foundation

23 Balmoral Avenue

Kingston 10, Jamaica