DEAR DR. DONOHUE: I live in an area of small towns. In the town nearest me, a young boy suddenly died after a basketball game. How could that happen? Aren’t the players medically screened before the season starts? It’s said he died of a large heart. What does that mean? — A.L.

ANSWER: The death of a young person is always a tragedy. The sudden death of a young athlete is an intolerable tragedy because these young people are the picture of health. Such deaths are said to happen in one out of 50,000 to 133,000 young male athletes every year in the United States. Most schools required a doctor’s exam before a student is allowed to participate in athletics. However, many of these boys have no signs of heart disease and have never complained of any suspicious symptoms, like chest pain, shortness of breath or fainting spells.

I take an “enlarged heart” to mean hypertrophic cardiomyopathy, the heart condition that is most frequently cited as the cause of death in young athletes. In half of those with this condition, genes are responsible for the heart’s enlargement. In those boys, a close examination of their family history often reveals relatives who died young and unexpectedly. The heart enlargement that comes from hypertrophic cardiomyopathy takes place in areas of the heart that make it difficult to pump blood out of the heart. That is the cause of death. It usually happens during play or just after completing play. Quite often, a physical examination of the heart reveals a heart murmur. Further investigation with an echocardiogram (sound-wave pictures of the heart) demonstrates the abnormal enlargement, and the difficulty the heart faces in pumping blood.

Hypertrophic cardiomyopathy isn’t the only cause of sudden death in young athletes. Abnormalities of the heart arteries, infections (often viral) of the heart muscle and an assortment of conditions — usually present from birth, and usually difficult to detect — are documented to be lethal heart disorders that lead to death during vigorous exercise.

As for additional screening, an ongoing debate centers on the use of an EKG as part of the requirements for athletic participation. It’s an unsettled issue. I’m for it.

DEAR DR. DONOHUE: What is the pain that suddenly springs up under the ribs while running? It happens a lot to me. What causes it? How do you get rid of it? Sometimes I have to stop and sit for five minutes before it goes. — L.F.

ANSWER: That’s a side stitch. Some say it’s a cramp in the diaphragm muscle, the chief breathing muscle. Others say it comes from a shunting of blood away from the diaphragm to the legs. A third explanation is that abdominal organs are pulling on their supporting ligaments when the feet strike the ground.

One way to end a side stitch is to bend forward while simultaneously tightening the abdominal muscles and digging your fingers into the painful area under the ribs. Another is to stretch your arms over your head while deeply inhaling. A third is to inhale while bending over, then staying in that position and exhaling through pursed lips.

DEAR DR. DONOHUE: I have been a dedicated long-distance runner for 15 years. I enter at least two marathons every year. My lower body is well-developed. My upper body looks like I am on a starvation diet. What can I do? — J.B.

ANSWER: Almost all long-distance runners have a lean upper body. It’s an adaptation the body makes to run long distances.

You can build your upper body by cutting back on your distance running and by taking up weightlifting. Along with weightlifting, you have to increase your calorie intake.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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