HCM and Young Black Athletes: Essential Insights for Parents and Coaches

Did you know that hypertrophic cardiomyopathy (HCM) is a leading cause of sudden cardiac death (SCD) in young athletes? Yup, you read that right, HCM is one of the most common causes of sudden death among young athletes, and I’m sure you’ll be surprised to know that this condition often goes undetected, particularly in Black communities. According to the American Heart Association, “SCD disproportionately affects Black athletes and is more frequently linked to competitive sports that involve sudden movements, like football or basketball. Most people show no signs or symptoms before SCD.” 

In Black communities, symptoms may be overlooked, misinterpreted, and access to specialized care is slim to none. For parents and coaches of young Black athletes, fully understanding HCM goes way beyond medical concerns and/or issues. It’s about ensuring safety, making well-informed choices, and advocating for their needs. In this article, we’ll explore why HCM deserves a special focus in the Black community, highlight key signs and symptoms of HCM, diagnosis, and go into detail about actional measures that parents and coaches can implement to safeguard young Black athletes while also supporting and nurturing their passion for sport. 

If you’re not familiar, hypertrophic cardiomyopathy (HCM) is an inherited/genetic heart condition where the heart muscle thickens abnormally, making it harder for the heart to pump blood effectively, as the thickening can block blood flow, and sometimes causes irregular heartbeats and disrupting heart relaxation.

Hypertrophic cardiomyopathy (HCM) deserves special attention within the Black community concerning young Black athletes. This isn’t because HCM is more prevalent, but because it’s frequently diagnosed too late due to limited access and systemic barriers, such as a lack of sports cardiologists, delayed referrals after symptom presentation, and fewer tests and screenings.

Furthermore, it often goes completely unnoticed, overlooked, or misinterpreted. HCM symptoms in young Black athletes are more likely to be minimized or normalized. Consider for a moment how often you’ve heard phrases like, “He/she’s out of shape,” “Going hard/overtraining is what we do,” or “It’s just asthma.” Reflect on the pressure to “push through/work harder.” Now, visualize an athlete who is out of breath, dizzy, experiencing chest pain, or having palpitations, while being told these things. These are symptoms that should not be normalized within our community. This actually delays evaluation of HCM red flags.

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Some other factors as to why HCM deserves a special focus in the Black community, as it pertains to young Black athletes:

• HCM in young Black athletes may overlap with other conditions that are more prevalent in Black populations, like sickle cell trait/disease, hypertension- related conditions, and asthma misdiagnosis. These are a few conditions that may distract from HCM evaluation and diagnosis. 
• Not knowing or having an incomplete family health history puts young Black athletes at a disadvantage. Family screenings in the Black community have traditionally been less prevalent.  
• The fact that there is a lack of diversity in genetic studies/ underrepresentation in genetic databases makes it super difficult to confirm and counsel. For example, genetic variants in Black patients are more likely to be labeled “variants of uncertain significance,” which doesn’t give a clear understanding of what’s actually going on.

The bottom line is, when young Black athletes receive swift and expert cardiac evaluations, their outcomes improve significantly. Recognizing the signs and symptoms of HCM in young Black athletes is essential.

Signs and symptoms of hypertrophic cardiomyopathy (HCM) often include:

• Lightheadedness/dizziness during or after activity
• Fainting or near-fainting, especially during or after activity/exercise
• Fatigue/weakness
• Shortness of breath
• Chest pain during and/or after physical activity
• Swelling in the legs, ankles, abdomen and neck veins
• Heart palpitations (irregular heartbeats, fluttering, racing)
• Heart murmur

Let’s say your athlete shows no signs or symptoms of HCM. Here are some red flags that should raise concern:

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• Family history of known HCM
• Unexplained seizers 
• Sudden unexplained death under the age of 50
• Prior diagnosis of an enlarged heart
• Unexplained drop in athletic performance

Sudden cardiac deaths in young Black athletes are often preventable with proper screening and early action. With a shared responsibility between parents and coaches, I’ll explain how this is so. 

Actionable measures that parents and coaches can implement to safeguard young Black athletes:

• Never ignore symptoms
• Ensure that pre-participation sport physicals are thorough 
• Encourage honest reporting–athletes may sometimes hide symptoms because they are eager to play, have a fear of losing ample playing time, or fear of losing scholarships
• Ensure emergency action plans are in place
• Ensure AEDs are accessible during all games and practices
• Encourage family health screening

Diagnosing hypertrophic cardiomyopathy (HCM) involves a comprehensive clinical approach that integrates history, imaging and risk evaluation. Diagnosis is not based on a single test and may include tests and screenings such as:

• Stress test – assess performance/heart function during physical activity, identifying any blockages in blood flow. 
• Heart murmur screening – a trusted healthcare provider uses a stethoscope to listen for an abnormal sound indicating turbulent blood flow. 
• An echocardiogram (ECHO) – which shows how big your heart is and if the chambers are enlarged, the effectiveness of how the heart muscle pumps blood, valve function, the blood flow/direction and speed of blood moving through the heart, and any structural issues like clot defects or the sac around the heart.
• Electrocardiogram (ECG) screening – detects electrical changes from potential thickening and also shows abnormalities.
• Cardiac MRI – provides highly detailed visuals to assess muscle thickening and the presence of any scar tissue. 
• Genetic testing – identifies gene mutations. This option would be helpful for those with a family history of known HCM.

Armed with the right knowledge and proactive support, young Black athletes can pursue sports and their talents more safely, supported by their parents and coaches who emphasize both their sports potential and their enduring cardiovascular health.

Safeguarding the health and future of young Black athletes demands awareness, attentiveness and teamwork among parents, coaches, and specialized healthcare providers. By understanding hypertrophic cardiomyopathy (HCM), recognizing key symptoms, early warning signs, advocating for appropriate screening and proper care, parents and coaches can play a critical role in preventing sudden cardiac death in young Black athletes.