I’m not a hockey fan, I’ve probably watched two games to completion in my life. I don’t have anything against hockey, its just not my thing. That’s why it was so strange that I decided to flip on the Dallas Stars game on the evening of March 10th. Maybe it was because I was bored with the other thousand offerings on my television, maybe I was depressed because there were STILL no Ranger games being broadcast, maybe I was looking to get one more blast of winter in an effort to get the spring going fully. Who knows. The end result is that I switched over to the Stars game and immediately knew something terrible had happened.
The shot that greeted me was that surreal shot of the crowd, the one they go to when they are purposely not showing the ice. Over the next few seconds it became clear that Rich Peverly had collapsed on the bench and was getting urgent medical attention a few yards away in the tunnel. Later we would learn he had lost consciousness and had to be shocked in the tunnel to restore his pulse. In the last few days we have heard some vague reports about what may have actually happened but nothing concrete. So, let’s take a look and see if we can sort out what may have happened and what the likely outcome is for Peverly.
First, a bit of cardiac anatomy is probably going to be helpful. The human heart has four chambers, two atria and two ventricles. The atria serve to pump the blood down into the ventricles, which then pump it out to the body. The right atrium and right ventricle accept blood from the veins and pump it to the lungs, where it receives oxygen. The left atrium takes that oxygenated blood and pumps it into the left ventricle where it is then pumped out to the body. With me so far? The electrical system of the heart is mainly located in an upper part of the right atrium, an area called the sinus node. This collection of cells serves to create the electrical impulse which makes your heart beat. It controls your heart beat, speeding it up when you are exercising (or watching Prince hit a moon shot into the home run porch) and slowing it down when you are resting. In most people this system works flawlessly and you go on to live a happy and normal life, maybe you even get to play hockey for the Dallas Stars.
So, what went wrong with Peverly? We know from statements by medical staff that treated him at UT Southwestern Medical Center that Peverly had been diagnosed with atrial fibrillation and had undergone some treatments for this problem prior to the season. Atrial fibrillation is a condition where a part of the left or right atrium decides to start firing off its own abnormal electrical impulses, ignoring the sinus node. These impulses are usually irregular and very rapid. They bombard the ventricles (the pumping chambers) with electrical charges, causing the ventricles to pump very rapidly and erratically. If the pulse gets too fast (above 150 or so) then you can start to have problems with the ventricles not being able to fill with blood properly and the blood pressure falls. If the blood pressure falls too much, you pass out as Peverly did.
The doctors who treated him said they shocked him one time and were able to restore a normal heart rhythm. This procedure involves applying a significant electrical current to the chest (think back to watching those old episodes of ER…CLEAR!!) which then resets the whole electrical system of the heart and hopefully allows the sinus node to take back over and restore normal pumping function. I suspect this is what happened with Peverly. There are reports of his “heart stopping” for a short time. This is very unusual in atrial fibrillation unless it occurred during the shocking procedure, in which case they would have had to shock him again to restart the heart (which was not reported). It’s possible that he did not have a pulse on the bench due to the rapid heart rate and very low blood pressure, this might have seemed as though his heart “stopped” to the initial responders although it actually never stopped beating.
At any rate, we now know that Peverly was hospitalized and successfully treated for this condition. The problem is that the area of the heart that caused the atrial fibrillation in the first place is still there. It could still go off at any moment and cause the same problem.
So, what’s in the future for Peverly?
My guess is that he will undergo some form of ablation procedure. This is where doctors will find the problem area using a surgical procedure where a catheter is fed into the heart which can detect these electrical signals. Once they find the problem area, they will burn it with high frequency radio waves, killing the abnormal heart cells. It will turn into a scar and should not cause him further problems. He certainly will not play again for the Stars this year. Whether he is able to play again at all is doubtful. He would have to undergo a successful ablation procedure and prove that he can exercise to high levels without further heart problems before any doctor would release him to play hockey.
My guess is that this is the end of Rich Peverly’s playing career.