Fibrillation wouldn't threaten career

The Red Sox released few details about David Ortiz's medical condition yesterday, but cardiologists said several clues, including the decision not to rush him to a hospital in Oakland where the team is playing, indicate he probably is not suffering from a life-threatening or career-ending illness.

Heart specialists said the most likely cause of what the team described as an irregular heartbeat is atrial fibrillation, a common condition caused by faulty electrical signals in the heart and experienced by more than 2 million Americans.

Dr. Mark Josephson, chief of cardiovascular medicine at Beth Israel Deaconess Medical Center, said some athletes experience the condition in the summer, because both high adrenaline levels from physical exertion and dehydration can bring on the condition's hallmark palpitations. Underlying diseases such as diabetes and high blood pressure, as well as stress, caffeine, and other stimulants also can cause atrial fibrillation, though the cause often is unknown.

Atrial fibrillation is not considered life-threatening, but it can have long-term serious consequences if not treated. The symptoms, which include dizziness and shortness of breath, can be brief and infrequent, or persist for prolonged periods. In that case, patients can be at risk of suffering a stroke, and doctors usually prescribe beta blockers and blood thinners. Fainting could indicate a more serious condition.

``If all he had is palpitations, I don't think he would have a life-threatening arrhythmia," Josephson said. ``I don't think there's a rush to be aggressive if he's a happy guy who hit 47 home runs. I'd be calm about this."

Josephson and other cardiologists interviewed by the Globe cautioned that they have not examined Ortiz and have no additional information about his condition, so they are making informed guesses about his problem. Ortiz could have some other, less common type of arrhythmia.

Larry Bird revealed in 1999 that he was diagnosed with atrial fibrillation after his playing days but that he had symptoms of the condition while playing with the Celtics. And Democratic presidential candidate Bill Bradley, a former New York Knicks player, canceled several campaign stops during the winter of 2000 because of the condition.

Many conditions can cause an irregular heartbeat, including serious abnormalities of the heart, which often are detected with an echocardiogram, a test that uses sound waves to create a detailed, moving picture of the heart. Celtics star Reggie Lewis, for example, had episodes of fainting before dying in 1993 from an arrhythmia triggered by a structural defect in his heart muscle.

``The key thing about Reggie is he did not have a structurally normal heart," said Dr. Laurence Epstein, chief of the arrhythmia service at Brigham and Women's Hospital. ``With atrial fibrillation, there is no reason you shouldn't be able to have a full, active career without limitations."

Dr. Mark Link, a cardiologist and director of the center for the evaluation of athletes at Tufts-New England Medical Center, said atrial fibrillation is ``generally more of an annoyance. It's generally not something that kills people. It's treated because it's uncomfortable, and if it's frequent and lasts long, you have to worry about stroke. It should not impact his career."

The Red Sox released a brief statement yesterday saying Ortiz was admitted to Massachusetts General Hospital Aug. 19 ``where he was fully examined by specialists and a series of tests were performed. Based on the results of these tests, and David's symptomatic improvement, he was cleared to play."

When he experienced similar palpitations Monday, the statement said, the team decided to send him back to Boston ``to undergo further examination and testing to determine the cause of these recurring symptoms." Red Sox team internist Dr. Larry Ronan and a group of specialists will examine Ortiz.

Epstein said it's likely doctors performed an echocardiogram and other tests on Ortiz during the Aug. 19 hospital stay and determined his heart was normal, but they were not able to capture the irregular heartbeat because it was intermittent. This time, he said, they may be doing further tests to record the palpitations such as having Ortiz wear a special recording device. That is the most definitive way to diagnose atrial fibrillation -- or other types of arrhythmia.

``The fact that they're sending him back to Boston, without having him go to the hospital there, makes me think they know what it is and it's something benign," Epstein said.