SPECIAL REPORT : A Question...

The last place Stacey Olson expected to die was in the high school gymnasium where his identical twin died more than two years before.

And the last day Olson expected to die was Feb. 11, the day after meeting his cardiologist to discuss the possibility of inserting a device to control an irregular heartbeat.

Such is the tragic twist that struck Liberty High and the Eastern Washington community of Spangle where Olson, 17, was a promising athlete.

Although he did not die during competition, Olson’s case illustrates the complexities of dealing with athletes suffering from heart problems.

The National Center for Catastrophic Sports Injury Research at the University of North Carolina, which monitors sports-related fatalities during games and practices, published data this month portraying sudden-death syndrome as the primary killer of athletes.

The latest statistics, collected between 1982-1990, represent what many physicians believed for some time--deaths caused by cardiac disorders far outnumber on-the-field accidents.

For the past decade, physicians have been searching for better ways to pinpoint high-risk athletes. Among the millions cleared to play each year after undergoing routine preseason examinations, some with heart disease slip through.

And sometimes, all the precautions in the world cannot stop the inevitable, as those monitoring Stacey Olson discovered.

Olson was closely watched after his twin, Tracey, died of cardiac complications that were traced to a viral infection in October of 1989. Tracey, who had fainted, had stopped practicing with the school football team days earlier.

Nothing unusual was noticed until Stacey passed out during a playground football game last April. A treadmill test discovered Olson had an arrhythmia, or irregular heartbeat. Further testing revealed his heart wall had suffered damage from an old virus, similar to his brother’s.

Olson was given medication to control his heart rate. His activity was curtailed. He was fine until he became lightheaded during a volleyball game in December.

After that episode, he was ordered to stop all physical activity as doctors weighed their options. The onetime football and basketball player became a teacher’s assistant for physical education classes.

Olson was setting up badminton nets as part of those duties when he collapsed about 50 feet from where his brother died in the Liberty High gym.

School officials were prepared. Basketball Coach Denny Gowan performed cardiopulmonary resuscitation to try to revive him. Paramedics were immediately called. So was a helicopter to transport Olson to a Spokane hospital.

In the end, nothing could save him.

Already this year, a number of athletes have died suddenly.

--Vernon Crenshaw, 19, a starting point guard for Pasadena Blair High, died during a pickup game March 6. The L.A. County coroner’s office attributed death to hypertrophic cardiomyopathy, an enlargement of the heart.

--Duke Wallenborn, the leading scorer for Western Washington in Bellingham, Wash., suffered a heart attack at his apartment and died March 2. He was diagnosed with Wolff-Parkinson-White

syndrome, a congenital condition that produces an abnormal heart rhythm. Doctors told Wallenborn that playing constituted a minimal risk. He was planning to have corrective surgery after the season.

--Two basketball players from Manassas, Va., collapsed and died from heart disorders during practices only weeks apart in January. One, 16, had been cleared to play by school officials and a family physician despite being his condition diagnosed as a heart murmur. The other, 15, had a rare congenital heart defect that physicians said could only be detected in surgery.

--Former Oregon State guard Earnest Killum, 20, passed out while soaking a foot in a hot tub during the basketball team’s trip to Los Angeles in January. He died within 72 hours as a result of blocked arteries.

Results of a private autopsy have not been revealed, but Killum, a Lynwood High graduate, is believed to have died from complications undetected by a test after surgery to remove a blood clot.

On the day Killum was buried in Inglewood, Joe Rhett, South Carolina’s leading scorer who competed with a pacemaker, fainted during a game. He discontinued playing that night. After undergoing tests, Rhett decided to retire for the season.

Although such cases are well publicized, they are rare considering the millions participating in high school and college athletics.

“When you hear more of these stories you sort of see that just restricting their activity is not necessarily the answer,” said Steven Van Camp, a San Diego cardiologist who is a sudden-death expert. “We don’t take everybody with a heart murmur or everybody with an abnormal heart out of action.”

About half the sudden-death victims catalogued at the national registry at North Carolina suffered from hypertrophic cardiomyopathy, an enlargement of the heart. Those were followed by congenital coronary artery anomalies and Marfan’s syndrome, a connective tissue disorder.

Although physicians have identified the diseases and their underlying pathologies, there is some debate over how much more can be done to prevent death. This has become the lingering question for physicians who administer preseason physicals.

James C. Puffer, chief of the division of family medicine at the UCLA School of Medicine, estimates that one athlete in 250,000 to 500,000 suffers from diseases that cause sudden death. Because the numbers are so low, he wonders how much can be improved.

“I don’t think we can do much more than we’re doing right now,” Puffer said.

Robert C. Cantu, medical director of the North Carolina research center, said most sudden-death victims they registered had detectable--but unknown--signs of possible danger.

“So whereas it may not have been so easy to listen to their heart to detect an anomaly, in most instances the history was there to throw up a warning flag,” he said in a recent interview at the American College of Sports Medicine team physicians training course in Palm Springs.

Cantu said his latest data, published in the March issue of Medicine and Science in Sports and Exercise, indicates team physicians need to seek detailed information during physical exams.

Recent focus on sudden death comes at a time when fatalities in sports are declining. The incidence of football deaths is at an all-time low because of better protective equipment and rule changes, experts said. In 1990, no high school football-related fatalities were recorded by the national registry, a first since the tracking of these deaths began in 1932.

Cantu, a neurosurgeon at Emerson Hospital in Concord, Mass., said sudden deaths now outnumber direct incidents such as head injuries by two to one, “not because sudden deaths are going up, but because the others are going down.”

Furthermore, physicians made inroads in eliminating heat stroke deaths in the past decade as more coaches and trainers understand the value of hydration before, during and after competition.

Still, the data on heart disorders might not have immediate impact. Many say the screening process is as efficient as possible because escalating costs of health care makes most alternatives impractical.

“I have all these inner-city kids and echocardiograms cost between $200 and $500,” said Rosemary Agostini, a Seattle sports medicine specialist. “Who’s going to pay for it?”

In an effort to circumvent the burgeoning health-care costs, Agostini uses an old-fashioned approach to get results. When Agostini thinks she hears a heart murmur, she asks a cardiologist associated with her clinic to listen before ordering expensive tests.

Van Camp endorses the practice. “You don’t need the million dollar work-up (every time),” he said. “You need reasoned evaluation, (not) knee-jerk responses.”

Physicians say $1,500 cardiographic testing on every participant, while not only impractical, would waste time because of the small number at risk.

Another option could be a cardiovascular ultrasound examination that is being studied for its effectiveness in screening athletes. Timothy Hart, director of nuclear medicine at the Iowa Heart Center in Des Moines, is using the technique to evaluate the frequency of undetected heart disorders in high school athletes.

Hart found five abnormalities at a recent screening of 135 Southland athletes at the Long Beach Memorial Medical Center.

When the study is finished, Hart will compare the results of 2,000 football and basketball players whom he screened against national averages from routine physical examinations.

“If we take the time to do a physical examination, we probably should take the time to give the best shot at making an accurate diagnosis,” said Michael Crade, medical director of the ultrasound department and vascular laboratory at Long Beach Memorial.

But Crade said it is unclear whether ultrasound would be cost-effective during physicals in which hundreds are examined at once.

Without the benefit of ultrasound or other sophisticated tests, doctors say a complete physical and history at the beginning of the year, and if possible, at the start of each season, is the most practical approach to date.

Van Camp said most exams are so generalized that they should be routinely administered to all youngsters.

Physicians follow loose guidelines when looking for clues of congenital cardiovascular disease. They usually begin with a detailed family history to try to determine whether any family member died before age 30.

A family history, however, is not fail-safe. UCLA’s Puffer said the gene that displays heart disease might skip some generations.

An equally difficult task is persuading college-aged athletes that it is in their best interest to be forthcoming. Young athletes are so eager to play they often hide past medical problems.

“If he knew this may pull him out, he may not own up to it,” Cantu said.

Because the unreliability of histories, other factors must be considered when checking for heart disease.

As Cantu noted from his study, fainting spells or chest pains during exercise are good clues. Although such situations, known as syncope, do not necessarily indicate heart problems, they are the kind of signs that call for further examination.

Finally, heart murmurs, once properly identified by a specialist, should prompt aggressive testing such as stress tests, echocardiograms and electrocardiograms, Puffer said.

Then again, some conditions are not present until an individual dies from a heart attack while undergoing strenuous activity.

Agostini handled such a case.

In 1989, she was the physician for Cleveland State men’s basketball team when Paul Stewart, 19, died of a heart attack after playing in a pickup game. An autopsy revealed he suffered from hardening of the arteries.

“Physically, he had played well enough to go to the NCAAs,” Agostini said, adding the team played an up-tempo running game. “He didn’t have any more sore throats or any more shortness of breath (than his teammates).

“We didn’t have any warning signs. No episodes.”

Until he died.