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Kile's condition not easily detected during physicals
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06/24/2002 11:02 pm ET 
Kile's condition not easily detected during physicals
By Jim Molony / MLB.com

The condition that may have attributed to the death of St. Louis Cardinals pitcher Darryl Kile is common but not easily detected during typical physicals given to Major League baseball players each spring.

According to autopsy results, the 33-year-old Kile had 80 to 90 percent blockage of the three main coronary arteries that supply blood to the heart, and his heart was 25 percent larger than normal. Kile was found dead Saturday in Chicago.

Not all teams conduct cardiac screenings, or EKG tests, on players. The Florida Marlins are one team that does. The Marlins also do Lipid Profiling on each player, which tests for diabetes and cholesterol levels and other traits. The Marlins also conduct fitness tests on each player. All of this is done when players take their preseason physicals before Spring Training.

"We now do an EKG and they are read by a physician after they are read by a cardiologist," Marlins trainer Sean Cunningham said. "When you're talking blocked arteries, an EKG would not necessarily catch that. That's why sometimes we do Stress EKGs, which has a better chance, but still no guarantees. You're talking about a 33-year-old who is physically fit. You're not necessarily looking for it. That's why the American Heart Association calls it the silent killer."

The Marlins do a medical history profile of each player, checking for heart problems in the past. They check to see if there is a history of cancer, diabetes and a full list of things that might unveil whether a player is predisposed to a condition.

In 1999, a routine physical revealed third baseman Mike Lowell had testicular cancer. Lowell underwent surgery and was on the disabled list from March 26-May 29, 1999.

"We have a cardiologist see all of our players," said Dr. Timothy Kremchek, team doctor of the Cincinnati Reds. "If there's any type of a hint of a problem, they get worked up by the cardiologist. If there's any family history, it's up to the cardiologist to work them up a little more closely.

"We do and most teams do have cardiologists that see teams before the season ... (Between) cardiologists, EKGs, family history, lab work, I think we're doing everything. There's not much more to do."

Dr. Larry Pedegana, Medical Director of the Seattle Mariners, said the team has conducted cardiovascular stress tests -- called the "Bruce Protocol" -- for about 15 years during Spring Training.

As far as Pedegana knows, only the Cubs and Mariners conduct such a test that is designed to divulge similar problems that may be linked to Kile's death.

"We certainly will look at this because of what happened, but we have no immediate plan to change what we are doing."

Blockage such as that found in Kile is unusual for someone so young. However, atherosclerosis, or hardening of the arteries, is common. Atherosclerosis accounts for nearly three-fourths of all U.S. deaths from cardiovascular disease, the nation's leading killer, according to the heart association. Atherosclerosis kills more than 15,000 Americans each year.

While most Americans who die of heart disease are 65 or older, research shows that 80 percent of heart disease deaths in younger people occur during the first attack. In 50 percent of men who die suddenly of heart disease, there were no previous symptoms.

"A very substantial proportion of patients with heart disease never have a clue, and he might have been one of them," cardiologist Dr. Eric Topol, chairman of cardiovascular medicine at the Cleveland Clinic, told The Associated Press.

Kile's narrowed heart arteries, probably caused by a buildup of fatty plaque deposits, could have been symptomless -- or could have triggered vague signs he might have blamed on the strain of pitching, Topol said.

Kile did complain of shoulder pain and weakness the night before he died -- symptoms that could have been caused by his heart or by his sport. The death of Kile's father from cardiovascular disease in his 40s should have been a red flag. Cardiovascular disease that shows up at a young age is often hereditary.

With or without symptoms, patients with a strong family history should get rigorous routine checkups including tests such as cholesterol screenings, blood work-ups, exercise stress tests or heart imaging tests, Topol said.

Topol said such tests probably would have detected Kile's narrowed arteries, which could have been treated with an angioplasty and stent procedure, in which a balloon-tip catheter unclogs the arteries and a tiny mesh coil is inserted to keep them propped open.

The heart association estimates that more than a million angioplasties are done each year nationwide.

Kile had an electrocardiogram during Spring Training that showed nothing abnormal, but such tests can be normal in someone without previous heart damage, Topol said.

"This is happening every day, but it's just that people are not as visible as Mr. Kile," Topol said. "We have a lot of work to do to get the medical community and the patients to heighten awareness and to get the appropriate diagnostic workup -- and not just once" for people with strong risk factors."

Jim Molony is a writer for MLB.com based in Houston. He can be reached at mlbmolony@aol.com. The Associated Press, Florida Marlins beat reporter Joe Frisaro and Cincinnati Reds beat reporter Chris Haft contributed to this report. This story was not subject to the approval of Major League Baseball or its clubs.





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