A new team will soon be calling the University of Nebraska’s Memorial Stadium home, but not the typical group you would expect to see in UNL’s new East Stadium expansion. This 11-member team is made up primarily of physicians whose No. 1 goal is to prevent sudden death in athletes.
The team, Bryan Heart Athlete Care — a partnership with the University of Nebraska in Athletic Cardiology and Research — is establishing a leading-edge research center that will study student-athletes’ hearts to discover warning signs that could help predict heart attacks.
Cardiovascular problems in athletes are unusual but not rare, and they’re catastrophic when they occur. But reliable data on predicting cardiac problems in athletes isn’t available.
"Normal findings often are not definitively established in all athletic situations," says program director Steven Krueger, MD (pictured below). "One of our first projects will be to help establish normals." Though those participating in basketball or football have the highest incidence of sudden death, the center will study athletes in many sports because each sport is unique in how it affects participants’ hearts.
University of Nebraska Athletic Director Tom Osborne, PhD, explains, "They are going to do longitudinal studies where they do a complete cardiology workup on many of our athletes. Traditionally student-athletes are given EKGs and some other rather cursory cardiovascular examinations, but they do not receive echocardiograms and other diagnostic devices."
The program will begin with student-athletes at UNL and other Big Ten schools before expanding throughout the NCAA. The findings will then be translated to other groups, such as high school athletes and adults in general.
For 20 years, Bryan Heart has been involved in athletic cardiology at the University of Nebraska from a consulting standpoint. Lonnie Albers, MD, medical director at the University of Nebraska, and Dr. Krueger, a cardiologist with Bryan Heart, had been discussing the need for research to develop better protocols.
During this time, Dr. Osborne — spanning his career as coach, congressman and UNL athletic director — was concerned that everything possible was done to provide athletes the best cardiac care.
"So, it was a Perfect Storm, with everything coming together," says Dr. Krueger. "The university then came to us and said they would like us to consider establishing a research program in their East Stadium."
"Doak Ostergard, the outreach director for UNL athletics, and I talked to Steve Krueger, as he has had most of the ideas for research in regard to cardiology in the facility," recalls Dr. Osborne, who adds. "I wish I could take full credit, but I can’t."
In addition to the clinical goal of identifying athletes at risk and managing their problems, the program has three primary research goals:
1) To identify the most pertinent issues which need to be addressed in athletic cardiology;
2) To develop and help lead a network of athletic cardiovascular specialists in additional research facilities across the United States and beyond; and
3) To establish research protocols for most critical issues.
The need for protocols
Cardiologists have seen their involvement grow in relation to clearing student-athletes for competition. Most pre-competition physicals for student-athletes are conducted by primary care physicians. But since there are not widely accepted protocols for assessing athletes’ cardiovascular health, more primary care physicians are referring patients to cardiologists or at least asking for consults regarding some aspects of their patients’ eligibility for sports participation.
Physicians don’t want to disqualify an athlete unnecessarily, but doctors aren’t sure how significant their observations are or test results since there is very little data available. This is where protocols are needed. In addition to establishing protocols for sports physicals, Bryan Heart Athlete Care will establish a panel of athletic cardiologists from around the country to help make participation and return-to-play recommendations for athletes who have cardiac symptoms and conditions.
"Whether it is a physician in Kentucky or one in greater Nebraska, we will be available to help answer questions on difficult cases," says Dr. Krueger.
There are a lot of complaints that present in athletes that may or may not be related to the heart, such as chest pains, shortness of breath, heart palpitations, passing out and decreased exercise capacity. These are all things Dr. Krueger says physicians should be assessing, as well as family history of heart disease.
"Our goal is to prevent episodes from occurring in the first place," team member Christine Lawless, MD, says. "We have to raise the awareness, raise the education and raise the bar on how we should be clearing athletes to play."
Dr. Lawless directs research
Photo: Dr. Christine Lawless is flanked by cardiologists Todd Tessendorf (left) and Steven Krueger of the Bryan Heart Athlete Care program.
“When we decided to establish this program, we looked for the most experienced person in the country to lead the research team,” says Steven Krueger, MD. “And we were able to convince her to join us.” That expert is Christine Lawless, MD, who will be directing the research portion of the new Bryan Heart Athlete Care program as director of Athlete Cardiac Research.
“We’ve been involved in athletic cardiology for a long time, but by bringing Dr. Lawless on board, we will be able to focus more on the research that is so desperately needed in this area,” says Dr. Krueger. In addition to leading the research effort, Dr. Lawless will be involved in clinical consultations.
The only physician in the United States who is board certified both in cardiology and sports medicine, Dr. Lawless has been practicing medicine for 30 years and is widely known for her clinical skills and research. She is co-chair of the American College of Cardiology Council on Sports and Exercise Cardiology and is a member of the associate faculty at the University of Chicago. Dr. Lawless has published extensively in peer-reviewed journals, including New England Journal of Medicine, Journal of the American College of Cardiology and Medicine and Science in Sports and Exercise (the journal of the American College of Sports Medicine). Her book, “Sports Cardiology Essentials,” was published in December 2010.
A competitive figure skater until her late 40s, Dr. Lawless serves as team physician to U.S. Figure Skating world teams and is the official cardiology consultant to Major League Soccer and its teams throughout the United States and Canada. “There has not been enough medical research into the issue in the United States,” Dr. Lawless says. “One in 200,000 athletes will die from heart disease while playing sports. I’m excited to be part of a team whose goal is to prevent this from happening.”