It’s lying season! Or is it!? This time of year brings all sorts of new information out, the final touches of a mosaic of highly touted prospects’ draft projections. Some rise, some fall, often due to this new information. Some information is total fabrication, some half-truth, and some unfortunately true. Regrettably, the latest news regarding Mississippi State EDGE Montez Sweat’s heart condition flagged at the Combine has finally been revealed. Tom Pelissaro of NFL Network revealed on Good Friday that Sweat has an enlarged heart. This revelation is so significant that apparently, four NFL teams have removed him entirely from their draft boards. Today’s article will identify what an enlarged heart is, how this will affect him, comparable NFL players who have dealt with this condition, and how this may affect his draft stock.

Before diving into what an enlarged heart is, here’s a basic anatomy lesson. The heart is made up of four chambers: two atria and two ventricles. The right atrium brings in deoxygenated blood from the veins, emptying into the right ventricle, which in turn passes it through the lungs to be oxygenated. Blood then returns from the lungs, entering the left atrium before emptying into the left ventricle, which then pumps it out through the aorta and to the rest of the body via the arteries.

https://www.diagramlink.com/heart-flow-diagrams/PHYSIOLOGY

There are a number of areas in the heart that can be affected by conditions or disease. Changes in heart size can be normal physiological changes from positive activities, including body growth and exercise. Negative activities and characteristics such as poor diet, high blood pressure, coronary artery disease, inactivity, smoking, and genetics can also cause increased heart size.

An enlarged heart, or cardiomegaly, is a condition in which the heart grows in size due to various demands and stresses. A lot of people would think, what’s wrong with a bigger heart? It’s going to pump more blood and make the heart more efficient! Theoretically yes, but those changes in the heart don’t mean the cardiac muscle is always stronger. In healthy athletes, the heart does increase in size to accommodate for the increases in activity demands and is usually not a concern. However, in health-compromised individuals, an enlarged heart can be the result of high blood pressure or coronary artery disease, which increases the likelihood for diagnosis of conditions such as congestive heart failure, blood clots, or heart attacks.

As the result of an enlarged heart, the left ventricle and septum thicken. The left ventricle fills up with blood, but the extra stretch of the muscle prevents an efficient contraction of blood out to the body, and as a result, blood gets backed up. When the chamber is backed up and stretched out, it also weakens the valves separating the chambers. So instead of a strong contraction between valve opening/closing, the valves are not closing fully, leading to further backflow. When the heart is not pumping effectively, the body does not get a sufficient supply of oxygenated blood and problems begin to occur over time. In order to counteract the decrease in blood pumped out, the blood pressure is raised, which puts further stress on the heart. In addition, coronary artery disease occurs when the arteries around the heart become damaged due to clogs and lack of effective blood flow, leading to the cardiac muscle not getting oxygen and not working as efficiently.

Symptoms of an enlarged heart can be nothing, or issues such as fainting, shortness of breath, chest pain, heart arrhythmias, or heart murmurs can arise, leading to possible blood clots, strokes, or heart attack. Chronic issues could include shortness of breath, swelling of the lower extremities, heart palpitations, chest pain, or fatigue. Most people would understand that most of these conditions could cause serious issues if not managed properly. Most of the more chronic issues mentioned above are the result of a poor lifestyle and primarily occur in older individuals, which thankfully does not include Sweat.

In light of all this grim information, one could think, “How can Montez Sweat play with an enlarged heart?” One possibility is that he may have developed this as the result of being an elite level athlete and large human at 6’6” and 252 lbs. He may have what is called athlete’s heart. This is when a highly trained athlete’s heart adapts to the cardiovascular demands such as running and weightlifting. This is more common in runners and cyclists who perform long distance training. This can also occur in other athletes, such as in the case of Sweat, in which the ventricular wall thickens and becomes stronger to push the blood out more effectively for activity’s demands. At this point, the heart is simply highly efficient and usually has no long term concerns. However, if this was the case, this would be a non-issue, as many other athletes would demonstrate similar changes to their heart due to exercise.

More likely, he could have a genetic predisposition that wasn’t detected until a full medical workup was performed at the NFL Combine. The concern is that an enlarged heart could be the result of hypertrophic cardiomyopathy. This is a genetic condition that can vary from no symptoms to symptoms such as fainting, shortness of breath, fatigue, high blood pressure, and heart palpitations. During exertion, the heart can become overloaded, sending it into an arrhythmia, which could further cause a blood clot to form or a heart attack. With Sweat being African American, he is already at higher risk for high blood pressure. African Americans are also 2-3 more times likely to suffer from hypertrophic cardiomyopathy compared to the rest of the population. Add in a possible family history, and this could be the smoking gun.

As a part of standard screening at the Combine, all health issues are assessed by an array of doctors. Specifically, the heart is screened by a battery of tests that can include EKG (electrocardiogram), echocardiogram, chest x-ray, or exercise stress tests. Most likely, his EKG test strip could have shown abnormalities in the QRS complex, which is when the left ventricle is active, indicating decreased ejection fraction.

https://www.practicalclinicalskills.com/ekg-strips

In addition to the possible abnormal tests, bradycardia (slow heart rate <60 bpm) may have been noted. However, this common symptom is not specific to an enlarged heart. Slower heart rates are found in well-conditioned athletes, and that alone doesn’t raise concern. The reason Sweat required further testing was that if the doctors find something, they don’t have the time to explore further when a problem comes up. He has since been cleared by his cardiologist, but what one doctor says doesn’t always mesh with what other doctors think. According to Pelissaro, no one else in the NFL currently has this specific condition, and it is worrisome enough that not all teams are comfortable taking what they perceive as a risk drafting Sweat.

Interestingly, there are a number of football players who have played with an enlarged heart, including DT Nick Fairley, DL Gaines Adams, DT Chester McGlockton, and LB Marcus Freeman. In addition, there was concern for DT Star Lotulelei and LB Reggie Ragland during the Combine, but both have since been cleared to play without complications in the NFL. With Adams and McGlockton’s deaths, along with the future of Fairley’s career uncertain, there is understandable concern for Sweat that may lead to his draft slide, but it won’t outright prevent him from playing in the league. It is possible that Sweat could pass out suddenly or become short of breath as the result of exertion through practice or a game. A direct blow to the chest, which in his line of work is a certainty, could cause a cardiac contusion, which could send the heart into a ventricular fibrillation, which makes the heart essentially quiver during a heart attack, leading to ineffective beating which, in turn, may result in death.

The specifics of Sweat’s condition compared to those previously mentioned players is unknown at this time. However, I do not believe his condition is that far off from the general conditions of an enlarged heart. I believe that this information was leaked to potentially alter Sweat’s position in the draft. Here is why this may be blown out of proportion:

1. He has gotten to this point in the draft process without being told he can’t play football.
2. Pelissaro mentioned that teams would have to have an AED on site at all times. Every professional sports team, college, and most if not all high schools have this available to all athletes at all times to reduce the likelihood sudden cardiac deaths.
3. Other players have played with an enlarged heart and have had productive careers.

While he may be at a risk for the above complications, if he was truly at risk, he would have been ruled medically ineligible, similar to what occasionally happens to NBA prospects when they’re diagnosed with Marfan’s Syndrome and have to retire.

Overall, Sweat will be drafted, quite possibly still in the first round, and will most likely produce for whoever picks him. The length of his career may be shortened, but with constant monitoring and medical advances, he may still be able to maximize his opportunity both athletically and financially. There is an inherent risk in playing football; this is just another one of them. I am sure Sweat is fully aware of his medical status and has gotten the medical assurance that he is safe to play. Frankly, this information may have been released in order to drum up clicks for news sites and drama in the final days before the Draft. Really, anything can happen in the waning days leading up to the Draft, which makes it both exciting and frustrating. I personally can’t wait until Thursday to get some definitive answers.

Thank you to Cover 1 for allowing me to provide injury analysis on upcoming draft prospects prior to the draft. If you like what you read, make sure to follow Banged Up Bills on Facebook, on Twitter @BangedUpBills, on Reddit at u/BangedUpBills, and online at www.bangedupbills.com. Thank you for reading and GO BILLS!