Tyrek Coger’s Twitter account is frozen in time.
The 6-9 Oklahoma State basketball player from Raleigh had big dreams when he headed to Stillwater, Oklahoma, last summer.
His Twitter home page features these final lines on his bio below a photo of him playing basketball for Cape Fear Community College:
“life has its ups and downs. strive for success,” Coger wrote.
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He was certainly striving for that success on July 22 when he and his teammates ran the stairs at Oklahoma State’s football stadium at 5 p.m. in triple-digit heat.
The 22-year-old Coger showed no signs of distress while completing the drill, but once it was completed he sat down and collapsed. The school had strength and conditioning staff on hand and a 911 call was made. But Coger died about 90 minutes later at a hospital, a victim of left ventricular hypertrophy or an enlarged heart.
An enlargement of the right ventricle caused 22-year-old Kirk Urso’s unexpected death on Aug. 5, 2012. The team captain on UNC-Chapel Hill’s 2011 NCAA champion soccer team, Urso was a member of Major League Soccer’s Columbus Crew when he fell into cardiac arrest while at a bar in downtown Columbus, Ohio. He died an hour later at a nearby hospital.
Two athletes who seemed to be in good health suddenly drop dead from undetected heart ailments. While such things seem unlikely, sudden cardiac death is the leading cause of death of athletes while participating in their sport. Congenital or inherited cardiac abnormalities, which lead to irregular heart rhythms that become fatal within minutes, are the main cause for athletes younger than 35. Coronary artery disease is the main cause for athletes 35 and older, according to a Journal of Internal Medicine report.
A team of medical professionals at Duke University aim to do all they can to make such deaths less likely.
On Saturday, April 22, Duke and the Heart Rhythm Society will hold the fourth Sports Cardiology and Sudden Death in Athletes Symposium at Duke School of Medicine.
The all-day event aims to educate physicians, athletic trainers and other health professionals with evidence-based updates to reduce the risk of sudden cardiac death.
“The incidents of this are super low,” said Dr. Jeff Bytomski, the team physician for Duke’s athletic teams. “But when it happens it’s pretty devastating. That’s the tough part about it in figuring this out.”
What schools are doing
For the last decade or so, the hot-button topic in sports medicine has been concussions. Every year since 1995 at least one middle or high school student has died playing football, with direct contact brain or spinal injuries responsible for one-third of those deaths, according to National Center for Catastrophic Sports Injury Research data.
Everyone is really worried about concussions and they should be. But this, to me, is a much bigger issue because it’s silent sometimes.
Hap Zarzour, Duke University athletic trainer
Equipment upgrades seek to prevent them and experts work to determine when the time is best to allow an athlete to return to play after suffering one.
Hap Zarzour, an athletic trainer at Duke since 1992 who works primarily with the school’s football team, said cardiac issues should not be overlooked in the meantime.
That’s why he and Dr. Bytomski are among the Duke faculty presenters at the symposium.
“Everyone is really worried about concussions and they should be,” Zarzour said. “But this, to me, is a much bigger issue because it’s silent sometimes. The kid will be a really good athlete, they’ll be doing fine. Then all of the sudden they drop dead and you find out they had a pre-existing condition or they had a problem.”
More and more, NCAA Division I schools include cardiac testing for all incoming scholarship athletes as freshmen.
At Duke, that includes a simple EKG, which takes a few minutes and provides a snapshot of cardiac activity, including any irregular beats.
Some schools do more.
At the University of Virginia, the basic tests include an echocardiogram, which is an ultrasound test that provides a picture of the heart. It’s effective in examining the heart’s internal structure and blood flow.
Medical professionals around the country are constantly evaluating how much information they need and what they should do with it to prevent tragic deaths.
When abnormalities are spotted by the EKG at Duke, for example, that athlete is sent for further testing, which can include an echocardiogram or a cardiac MRI. That happens about 20 to 25 percent of the time, Zarzour said.
Sometimes, that means an athlete’s career is over and a potential tragedy has been averted. In other cases this information allows the athlete’s condition to be properly managed.
“It’s allowed people to play with things that can be evaluated and ruled out as being dangerous and treated certain ways,” Zarzour said. “So you are not eliminating every kid with any type of heart condition. ... You are able to really diagnose and get statistics and find out if it’s truly safe for them to play and how to make it safe for them to play.”
What can be done
Coger’s cardiac issues never surfaced. As a senior at Raleigh’s Upper Room Academy, a CAT scan of his head to check for a concussion discovered he had fluid gathering around his brain. He had surgery to remove the fluid and went on with his basketball career.
Shanda McNair, the mother of former N.C. State and Connecticut guard Rodney Purvis, became Coger’s adopted mother when he was 14.
She’s retained an attorney, who is seeking more details from Oklahoma State regarding Coger’s death.
The medical examiner’s report cited cardiomegaly with left ventricular hypertrophy – an enlarged heart and thickened left ventricle – as his cause of death.
McNair said she’s been advised to not speak publicly about Coger’s death, but she longs to help keep other parents from experiencing her grief.
“I am eager to start exploring ways that I can be helpful in terms of educating parents and student athletes on sudden cardiac death,” McNair said in a text message.
She’s in the early stages of establishing a foundation in Coger’s name aimed at doing just that.
Meanwhile, Duke’s doctors continue their work to establish best practices for athletes and their cardiac health.
The easy thing would be to have all athletes go through full cardiac testing once they arrive on campus as part of their initial physicals. But there are costs that factor into this decision.
While an EKG can be done for $250-300, an echocardiogram can cost between $1,000-$2,000. The cost of a more involved cardiac MRI is between $3,000 and $4,000.
In a small percentage of cases, false positives occur in the EKG stage that trigger further testing. In the end, the athletes are found to have no cardiac issues. But they’ve been through a stressful time nevertheless.
“It’s picking the right tests. It’s doing the evaluation,” Zarzour said. “It’s not doing just a bunch of things just to do them. More is not always better. But what are the tests that definitively rule this out or evaluate this? Or how do we interpret it and what does that mean?”
They are many medical professionals around the country researching these topics.
In February 2012, the American Medical Society for Sports Medicine co-sponsored a summit on EKG interpretation in athletes.
You say goodbye to players when they graduate and that’s one thing. Making that phone call to a mother, there’s no words.
Brad Underwood, Oklahoma State’s coach at the time of Tyrek Coger’s death, talking at a press conference in July 2016.
The result was the Seattle Criteria, which were developed to balance disease detection with false positives to give medical personnel clear guidelines.
Part of the problem, Bytomski said, is an EKG may show a cardiac issue for a person in the general population that in reality isn’t a concern for a well-trained athlete
“There are a lot of changes that are specific to athletes and not in the normal population,” Bytomski said. “You have to read it with those kind of glasses on to say an athlete is going to have some changes that are normal.”
In the end, the goal is to keep situations like those of Coger or Urso from happening.
“You say goodbye to players when they graduate and that’s one thing,” Brad Underwood, Oklahoma State’s coach at the time of Coger’s death, said during a press conference last July. “Making that phone call to a mother, there’s no words. It’s a tragic day.”
What: Sports Cardiology and Sudden Death in Athletes Symposium
Where: Duke School of Medicine, Trent Semans Center for Health Education, 8 Searle Center Drive, Durham, NC 27708
When: Saturday, 7:50 a.m.-3:55 p.m.
Cost: $80 for medical participants, $40 for non-medical participants, YouTube livestream available for $40.