Published August 24, 2009
ST. LOUIS – ST. LOUIS (AP) — An obese eighth-grader's sudden death during a football conditioning lap has revived discussion about whether testing children's hearts before they engage in sports or strenuous activity is necessary.
Anthony Troupe Jr. collapsed last week on a suburban St. Louis football field before he finished running a lap before practice. The oversized 13-year-old was pronounced dead at a local hospital an hour later.
The boy, known as "Big Ant" for his 6-foot-2-inch, 383-pound body, had a good work ethic and moved as fast and strong as boys less than half his size, coach Lonnie Jordan said.
"He knew he was a big guy, and knew what his job was as offensive guard, and defensive tackle," Jordan said. "He was proud of it."
An autopsy was performed but cause of death won't be available for several weeks pending tissue and toxicological test results, said Dr. Mary Case, St. Louis County medical examiner, adding that the boy's weight and heart are "certainly a consideration."
And, perhaps too, family history.
The boy's father, Anthony James Troupe Sr., collapsed and died at age 45 after working a night shift in April 2007. "He clocked out, and he clocked out," said Anthony's mother, Carol Howard. His death certificate states what roughly translates to high blood pressure and clogged arteries.
Dr. Keith Mankowitz, a professor of medicine at Washington University who specializes in prevention of sudden death in athletes, said 13-year-old boys don't die of morbid obesity.
"He had to have had some underlying heart problem," said Mankowitz, who suspects Anthony and his father had hypertrophic cardiomyopathy, the most common genetic heart condition that thickens the heart walls. It's also the most common cause of sudden death in athletes.
The condition may go undetected in routine screening, and would need to be confirmed by a heart specialist referred by a practitioner who grew suspicious of symptoms, a murmur or family history of sudden death, said Mankowitz, who directs an athletes screening program at Washington University.
He believes that every kid who want to play sports should get a good history and physical exam, and that if either uncovers a red flag, the student should be examined by a cardiologist, and receive periodic follow-ups. He said those are American Heart Association recommendations.
Dr. Cam Patterson, cardiology chief at the University of North Carolina, Chapel Hill, agreed that father and son may have shared the heart defect.
In Italy, a national screening program is credited with lowering the incidence of sudden cardiac death among young athletes, he said.
In the U.S., screening is the subject of debate, which centers around cost and the concern over an able athlete being held back because of non-definitive test results, Patterson said. He believes anyone who wants to engage in competitive athletics should have an EKG to detect problems resulting in sudden cardiac death in athletes.
"But do you do an EKG on 5 million kids to find 15 cases?" asks Dr. Robert Eckel, past president of the American Heart Association and professor of medicine at University of Colorado Denver Medical School. "It's a matter of cost and benefit."
On the other hand, he said, "If you're a parent who has lost a child, an EKG should have been done."
Eckel, an endocrinologist with a specialty in preventing heart disease, said that Anthony's extreme size suggests another possible problem such as a tumor producing too much growth hormone.
Most states require students to get physicals before participating in sports, "but will that catch everything? Probably not," said Bruce Whitehead, executive director of the National Interscholastic Athletic Administrators Association of middle- and high school athletic directors.
The physicals do not include EKGs that would detect subtle heart defects, but that shouldn't stop parents from getting extra tests when there is family history of heart problems, he said.
"There are 7 million student athletes across the U.S. annually, and that's just high school," he said. "It gets to be a matter of, do you test 7 million or isolate some students based on family history?"
Dr. John Galgani, who specializes in pediatric endocrinology, was the boy's pediatrician. He declined to discuss his case, citing confidentiality and an unwillingness to add to the family's pain.
"It's unimaginable to have this happen to your child," he said. "It's such a horrible thing to happen."
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