Week 14 Broncos at Chargers.

[Broncofan]

25 minutes ago, AKRNA said:

Is it really uncommon for the guy to have to spend the night? I'd think that would be almost common practice, just for observation. 

With blood tests and bedside cardiac ultrasound, you usually know within 6 hours if there's any unusual blood tests to suggest a problem, and a quick scan to indicate if there's anything dramatic (like UK allued to).   Most patients would go home after that 4-6 hour test if they were back in normal rhythm.  Now, in the US system, with payer insurance, it's certainly possible, though (it wouldn't happen in Canadian system, but again, this is the US).   

 

Renck's article does give a more important hint, though, at what's iikely:

 

 

Renck noting it's an irregular heartbeat - it's possible to have an irregular heartbeat with SVT, but it's far less likely.   Atrial fibrillation is far more commonplace if it was a fast and irregular rhythm (atrial flutter with variable block is the other one, but it's a lot rarer in young patients).  Having afib has more associated risks (stroke being the big impact risk) long-term than SVT (although again, it's not a career-threatener, because you can now usually find the focus that led to this, and literally zap it <ablation>).   So if you have afib, even if you flip back into a normal rhythm, there are guidelines that recommend blood thinners as there's a long-term increased risk of stroke (and recently, it's been found to still exist in theory, even if you're back in normal rhythm - since it may be a harbinger of more events) ....this opinion is still not uniform though, as young healthy adults still have the lowest risk (and blood thinners have their own risk). 

People may not remember this, but Graham Glasgow had this happen in 2021 - and back then, guidelines didn't recommend blood thinners be considered if there were no other risk factors and it was an otherwise healthy patient - so Glasgow was back at practice a week later.   He did miss 1 game, but it wasn't a season-ending situation, as they cleared him (and did not put him on blood thinners).  And while he hasn't been great, obviously it wasn't a career-threatener, either.

 

 

Obviously we don't have all the info, but knowing it's irregular and he stayed overnight, the odds do appear higher that it was in fact afib (SVT is rarely irregular and fast - still very uncomfortable if your heart rate is beating 160-180 non-stop, even with athletes).

If Meinerz had SVT, he's fine for the season.   If he had afib, then it depends on what studies they want to pursue & approach to take.  The most conservative opinion would be to fully anticoagulate him (use blood thinners) to reduce the risk of stroke, and then his season is done.  It's not a uniform opinion, although the US is probably the most frequent place you'll get this opinion (in Canada, they'd probably do a lot of studies, and decide based on what the studies show, but defer blood thinners if the patient is back in normal rhythm, and no prior history).

TL:DR - staying overnight & having an irregular rate does make afib more likely here.  If this is true, then the latest recommendations, if followed to the letter, could put Meinerz season at risk.   If it was SVT (which is less commonly seen as a rapid irregular rhythm, it's just really fast, but regular rhythm in young athletes), then he's fine.   And even if it's afib that happened, it will depend on the team specialist on whether they think he needs blood thinners.  In an otherwise healthy patient an first time, it's not a standard answer.   If he does go on that treatment, though - then the season is over.   So really, just need to wait and see what news comes.

Edited December 12, 2023 by Broncofan

[AKRNA]

9 minutes ago, Broncofan said:

With blood tests and bedside cardiac ultrasound, you usually know within 6 hours if there's any unusual blood tests to suggest a problem, and a quick scan to indicate if there's anything dramatic (like UK allued to).   Most patients would go home after that 4-6 hour test if they were back in normal rhythm.  Now, in the US system, with payer insurance, it's certainly possible, though (it wouldn't happen in Canadian system, but again, this is the US).   

 

Renck's article does give a more important hint, though, at what's iikely:

 

 

Renck noting it's an irregular heartbeat - it's possible to have an irregular heartbeat with SVT, but it's far less likely.   Atrial fibrillation is far more commonplace if it was a fast and irregular rhythm (atrial flutter with variable block is the other one, but it's a lot rarer in young patients).  Having afib has more associated risks (stroke being the big impact risk) long-term than SVT (although again, it's not a career-threatener, because you can now usually find the focus that led to this, and literally zap it <ablation>).   So if you have afib, even if you flip back into a normal rhythm, there are guidelines that recommend blood thinners as there's a long-term increased risk of stroke (and recently, it's been found to still exist in theory, even if you're back in normal rhythm - since it may be a harbinger of more events) ....this opinion is still not uniform though, as young healthy adults still have the lowest risk (and blood thinners have their own risk). 

People may not remember this, but Graham Glasgow had this happen in 2021 - and back then, guidelines didn't recommend blood thinners be considered if there were no other risk factors and it was an otherwise healthy patient - so Glasgow was back at practice a week later.   He did miss 1 game, but it wasn't a season-ending situation, as they cleared him (and did not put him on blood thinners).  And while he hasn't been great, obviously it wasn't a career-threatener, either.

 

 

Obviously we don't have all the info, but knowing it's irregular and he stayed overnight, the odds do appear higher that it was in fact afib (SVT is rarely irregular and fast - still very uncomfortable if your heart rate is beating 160-180 non-stop, even with athletes).

If Meinerz had SVT, he's fine for the season.   If he had afib, then it depends on what studies they want to pursue & approach to take.  The most conservative opinion would be to fully anticoagulate him (use blood thinners) to reduce the risk of stroke, and then his season is done.  It's not a uniform opinion, although the US is probably the most frequent place you'll get this opinion (in Canada, they'd probably do a lot of studies, and decide based on what the studies show, but defer blood thinners if the patient is back in normal rhythm, and no prior history).

TL:DR - staying overnight & having an irregular rate does make afib more likely here.  If this is true, then the latest recommendations, if followed to the letter, could put Meinerz season at risk.   If it was SVT (which is less commonly seen as a rapid irregular rhythm, it's just really fast, but regular rhythm in young athletes), then he's fine.   And even if it's afib that happened, it will depend on the team specialist on whether they think he needs blood thinners.  In an otherwise healthy patient an first time, it's not a standard answer.   If he does go on that treatment, though - then the season is over.   So really, just need to wait and see what news comes.

So them keeping him over night is probably just a precaution as Renck mentioned, right?

After 6 hours he's already missed the team flight anyway.

[Broncofan]

3 hours ago, MontanaBronco said:

In the case of paroxysmal a fib the plus side his chads2vasc is likely zero so I doubt they would anticoagulate him without seeing a thrombus on echo. SVT seems likely though. 

The KP-Rhythm 2018 study really has created a maelstrom of angst about what to do about these patients.   In Canada, we practice as you outline - we'd need to see some other real risk factor.   But I can't deny I've seen some very defensive medicine practiced in the US in high-profile cases (which is kinda wild, because honestly, it's not like the treatment doesn't carry its own risk, either).    What @broncos_fan _from _uk describes could very well happen in the US. 

There are literally dozens of articles on what to do with athletes, for the very reasons you cite.   To say it's a headache for the US is an understatement (again, in Canada - we opt for your scenario).    The American College of Cardiology even put out a position paper on afib and competitive athletes, and basically said "yeah, it's sticky, we hope future studies will help guide us (lol).   If you really want to read it, link's here:

https://www.sciencedirect.com/science/article/pii/S0914508718301230

 

Given what Renck noted about it being an irregular rhythm, afib becomes far more likely (if it was fast & regular, SVT almost certainly the case).

Glasgow's situation took place knowing the above data, and the specialists opted not to put him on blood thinners (which I'd support in my practice).   But there's definitely more variation in practice nowadays.   Knowing what happened to Glasgow, if this was afib, it would be mildly surprising to see Meinerz play this Sunday (especially as it's a cross-country road trip).  I'd expect if he had afib, he's going to get a repeat echocardiogram (cardiac US) and 2-to-7-day holter (box which follows your rhythm)...and then decide.   If it's the same staff as in 2021, they are somewhat predictable.  Obviously it depends if afib is confirmed, but going with Renck's report, that does seem most likely.

Edited December 12, 2023 by Broncofan

[Broncofan]

12 minutes ago, AKRNA said:

So them keeping him over night is probably just a precaution as Renck mentioned, right?

After 6 hours he's already missed he team flight anyway.

For any athlete, it's going to be precautionary, sure.  But if it was irregular, then the chances are it's afib.  And that's a less straightforward situation for the short-term.   For the long-term, he's going to be fine.   If it was SVT, then it's a non-issue, but again, Renck's post makes this less likely.

[broncos_fan _from _uk]

Yeah it’s looking like pafib. Fwiw in the military system where my primary job is, I am hard pressed to put younger guys who are very active on thinners, especially after their first episode.  I would assume the same here, but I have some fairly large local hosptial systems here where the hosptial protocol is to start on a DOAC and get a formal echo by a cardiologist in a week.
 

Reasons that he may have stayed over night: to get the formal echo by the cardiologist. The bedside is nice but especially for a big name, they may have wanted the heart doctor to see for himself in the morning. It could also have been due to the roll out of high sensitivity cardiac markers (troponin in particular) which has meant many of these guys now have detectable markers that didn’t before. Conservative doctors like to monitor that to make sure it goes down. In that same vein some very conservative doctors have a tendency to nearly admit every big name that comes through the door because they don’t want to be sued.

 

all of that to say, he likely gets d/c with a holter monitor. He will practice with it on but probably won’t play this week. If everything clears out he will play the rest of the season and get the ablation (the literally burn the problem cells away) that BF was talking about 

[The Helicopter]

Off football talk but I have a heart condition and as I age it's becoming a topic of discussion amongst the medical professionals in my life. The more information I obtain the more it feels like I don't know what I don't know...which leads to what questions should I be asking? What's not being discussed? Curious to get some more info from the medical professionals here. Who's interested in talking about the heart? Should I create a new thread?

[broncos_fan _from _uk]

@The Helicopter as long as it’s with the understanding that this is a general discussion and not about you specifically (for liability reasons) I’m happy to move this discussion to the random topics thread 

[AKRNA]

Just an observation from watching the replays each week but it appears we're starting to win quite a few one on ones at the LOS on both sides of the ball.  A far cry from the first few weeks of the season. Even our rotational DL guys are appearing much more stout. 

So, you guys see much more than I so is this a false impression or is it happening?

On another note, IMO this was our most impressive outing this year. As @MontanaBronco pointed out our last drive was a thing of beauty and something we haven't seen for years, like the TD/Elway/Shanahan era.

Consider, the Chargers just scored a TD on a 94 yd, 1:44 minute drive to drop it to a 10 point lead with 10:36 remaining. The next time they got the ball the lead was back up to 17 with only 3:11 left on the clock. It really is a great way to close out a game and a far cry from the 3 and outs we've been watching for years in the same situation.

I'm really liking this team.

[7DnBrnc53]

On 12/11/2023 at 12:07 AM, Broncofan said:

-Russell Wilson is still a problem.   Jeudy owns his drop and failure to get his toe-tap on the TD (as a guy who had his yardage prop and 1st alt line hitting, that's a 7U swing....doh).    But Wilson also had him wide open for a walk in TD.    We scored points today mostly because our run game wore the Chargers out, along with our D.  This is a problem next week, because the DET O has a great run game & OL, and they can play the ball-control game with Amon-Ra St. Brown and Sam Laporta in their WR corps.  Their pass D is atrocious though, and only has 1 pass rusher, so it's going to be crucial that we play better on O in the pass game (they have a decent run D, which is why we need to have a functional pass game next week).      The pick that put LAC in our RZ - late throw, and inside.    Exactly what you're not supposed to do.     Today's win changes nothing with Russ - he's our biggest problem, but hopefully his stock for an offseason trade rose.

I know that MHR is maligned here, but someone from that site agrees when it comes to Russ: 

https://www.milehighreport.com/2023/12/12/23998701/russell-wilson-is-not-the-answer

[Broncofan]

19 minutes ago, 7DnBrnc53 said:

I know that MHR is maligned here, but someone from that site agrees when it comes to Russ: 

https://www.milehighreport.com/2023/12/12/23998701/russell-wilson-is-not-the-answer

It's not even that controversial of a take IMO.   Courtland Sutton is playing great, but it's also not sustainable.   As a comp, George Pickens won 68+ percent of 50-50 balls and caught 19 contested catches last year - and suddenly has been at sub 30-percent this year.   
 

 

It's such a fluke that Sutton is making these plays at THIS HIGH of a rate.   With that understanding, and knowing how many open throws Russ has missed (yes Jeudy owns his drop on the LAC one)....yeah, this is the type of year you hope we can sell high next offseason.    Because regression is inevitable.   If you take away all the 50-50 balls hitting, you're left with one VERY limited QB.