Randon Hall, MD
The Curious Case of Montez Sweat
A huge storyline throughout the draft was the heart of one Montez Sweat LB out of Mississippi State. We are not talking about his will to succeed or his ambition to be a champion; we are literally talking about his actual heart. At the NFL Combine, Sweat was diagnosed with an undisclosed heart condition that cast doubt on his ability to play in the league. It wasn’t without drama and speculation of his supposed medical condition that he was drafted in the first round as the 26th overall pick to the Washington Redskins. I followed his story along with everyone else, but I don’t think the reporting did this case justice. Based on reports in the media, here is a complete breakdown of the condition he was believed to have had and how a misdiagnosis could have been made.
A Needle in a Haystack
Hypertrophic Cardiomyopathy (HCM) is a rare but devastating diagnosis for an athlete. The abbreviation is also pronounced “hocum”. HCM is a huge deal in the sports world for one major reason; it can kill you. The most difficult aspect of diagnosing this condition is that it is like looking for a needle in a haystack as it is believed that 0.06% of athletes have this condition. However, data shows that the most common individuals in sports to be affected are black athletes that play basketball or football.
Screening and Diagnosis
The debate regarding what type of screening tests are done is a challenging and contentious one. Some argue that all athletes should have an EKG done, as in the NCAA, which is believed to catch more than 95% of cases. However, others argue that the only way to truly be certain is to obtain an ultrasound (echocardiogram) of the heart and measure the thickness of the wall of the left ventricle. For argument sake let’s assume that the NFL does both an EKG and an ultrasound of the heart. To understand more about hypertrophic cardiomyopathy you have to learn a little bit about how the heart works.
In hypertrophic cardiomyopathy the inner wall of the left ventricle (aka septum) is abnormally thickened and composed of irregular muscle cells. These factors are the primary cause of the down stream effects of this condition.
One issue is that the thickened wall decreases the amount of blood that can fill the ventricle and eventually go out to the body on each beat. Secondly, due to the irregular muscle and thicker wall, structures can physically block the blood from getting out of the left ventricle. Lastly, the combination of these two features of this condition can predispose an athlete to develop an arrhythmia. The “lucky” athletes have some symptom such as shortness of breath, chest pain, or passing out with exercise, which prompts a workup and diagnosis. However, the most common presentation is simple for the athlete to collapse and die, with the diagnosis being made after the fact.
As reported by Ian Rapoport @RapSheet the initial wall thickness was measured at approximately “less than 2cm”. If an individual has a width of 2 cm they would certainly fit the criteria for HCM. However per this report the measurement is believed to include those papillary muscles that we mentioned before, which artificially increased the width measurement. On closer inspection, the wall was remeasured to 1.5 cm which would be within the normal range especially for an athlete with a well developed heart. The two differing opinions on the thickness of the wall by 0.5 cm was at the center of the entire issue. This discrepancy ultimately had a dramatic impact on his draft status. However, now, hopefully he can put this behind him and be the all-pro athlete he is believed to be.