This post was authored by Howard S. Bush, MD, FACC, member of the ACC’s Sports and Exercise Cardiology Section.

I am a practicing interventional cardiologist, interested in the cardiovascular evaluation and management of athletes, running the spectrum from the weekend warrior to those who play professionally.  You might ask “how” or “why” someone who opens blocked arteries would get involved in professional ice hockey.  In comparison to the other major league sports in our country, hockey falls a distant fourth in terms of things like revenues, salaries, fan interest, TV markets and organizational infrastructure.  Nonetheless, in December 1992, a patient of ours was awarded a franchise as the NHL expanded and we were asked to be involved in the medical care. My first experience with professional hockey was at the training camp in the summer of 1993 in Peterborough, Canada, with the late coach Roger Neilson. The rest is history. 

As an overview, the primary medical team for a hockey club in the NHL consists of the orthopedic surgeon and the primary care physician who usually specializes in either family practice-sports medicine or internal medicine. Other valuable members of the team include the team dentist, the chiropractor, and the plastic surgeon. The liaison between the players and the physicians is the Certified Medical Trainer – a highly skilled individual that is equivalent to an Army “medic”.

During my time with the Florida Panthers I have treated general medical issues ranging from preseason physicals with blood work and EKGs to colds, flu, rashes, concussions, sleep disturbances, asthma, and more. This season we dealt with an outbreak of the mumps, which affected several teams, although not ours.  In addition, to treating players, we have also been asked to provide support for family  members, coaches and front office staff. While I function predominantly as a primary care physician when covering the games, I have, on occasion, had to put my cardiology training to use. Cardiac events that I have been directly involved in include: an acute coronary syndrome in a 36-year-old play-by-play announcer resulting in 2 vessel PCI (he missed 1 game); crescendo angina in the mother-in law of the coach resulting in PCI; recurrent atrial fibrillation in a team executive  necessitating ablation; a 32-year-old player with an SVT (AVNRT) with rates of 220 bpm requiring ablation; a 27 year old with a hypercoagulbe state (protein C deficiency) resulting in DVT and PE requiring an IVC filter and long-term anti-coagulation; and finally a large PFO detected on a preseason screening echo in a rookie requiring a TEE to rule out an ASD.

Check out two other cardiovascular events around the league that have created national awareness:

An arrhythmia in a Dallas Stars player that required CPR and emergency cardioversion:

https://www.youtube.com/watch?v=1_e5WKFDg-E

The laceration of a carotid artery by a skate blade that was successfully stabilized on the ice and the patient was transported for emergency surgery:

https://www.youtube.com/watch?v=0pdTnprcJcI

The latter two events underscore the importance of emergency action plans and the coordination of the trainers, physicians, paramedics and the local emergency room.

My role as a sports cardiologist over the past 23 years has been exceedingly rewarding, and has complemented my “day job” as an interventional cardiologist. Although my entry into sports medicine was as an internist, my focus has now been directed toward the area of sports cardiology.  In this field, I have lived through the refinement of the screening of athletes – we now perform EKG’s on every player, every year, with a baseline echocardiogram performed when a player enters our organization for the first time.  These are elite athletes and it is important, and often not easy, to separate the abnormal and pathologic EKG from the physiologic adaptation of the high performance athlete.  Like many of us, there was some “on the job learning”, but there is nothing like experience.  I am sure that as we all contribute to and witness the emergence of the Sports Cardiologist, we will see more cardiologists involved in the day-to-day events of the professional sports team.

This post is part of a series of posts from the ACC’s Sports and Exercise Cardiology Section. For more information about the Section, click here. Follow the sports and exercise cardiology conversation on Twitter with the hashtag #SportsCardio.

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