Dr. David Bush, a congenital heart cardiologist at University Health, remembers the case clearly. In March 1990, Loyola Marymount University basketball star Hank Gathers threw down a dunk during a conference tournament game. Moments later, the 23-year-old collapsed on the court and died.
Gathers had collapsed once before and had been diagnosed with an abnormal heart rhythm. His death stunned the sports world and brought national attention to the cardiac risks that can affect even young, highly conditioned athletes.
The tragedy helped reinforce an important lesson for the medical and athletic communities: Looking healthy and performing at a high level do not always mean a person’s heart is free of disease.
“Every year we hear about student athletes with hidden heart problems collapsing during activities,” Dr. Bush said. “These events are rare, but they demonstrate why physical evaluations and accurate medical histories matter for students preparing to participate in athletics or marching band.”
How can a heart problem remain hidden?
Some conditions associated with sudden cardiac arrest affect the heart’s physical structure. Hypertrophic cardiomyopathy, for example, causes part of the heart muscle to become abnormally thick. A student may also be born with a coronary artery that follows an unusual path around the heart.
These structural differences may cause few or no problems while the body is at rest. During strenuous activity, however, the heart beats faster and needs more oxygen. An abnormally thickened heart muscle can interfere with blood flow or contribute to a dangerous heart rhythm. In certain coronary artery abnormalities, the artery may become compressed during intense exercise, restricting the supply of oxygen-rich blood to the heart.
Other conditions affect the electrical signals that control the heartbeat. Long QT syndrome, Wolff-Parkinson-White syndrome and other rhythm disorders can cause the heart to beat dangerously fast or irregularly. In some electrical disorders, the rise in heart rate and adrenaline that accompanies intense exercise can trigger an abnormal rhythm that may not occur during routine daily activities.
That is why many affected students feel completely healthy most of the time. Warning signs may not emerge until the heart is placed under greater strain. In some cases, the first noticeable symptom may be chest pain, unexplained shortness of breath, dizziness, fainting or a racing heartbeat during exercise.
“The incidence is rare, but because there’s a risk, all Texas students must have a physical exam before participating in sports, complete a medical history form that asks about symptoms and family history, and receive information about an option for an electrocardiogram, or EKG, which can check further for problems,” Dr. Bush said.
What happens during a sports physical?
A preparticipation physical evaluation is broader than a heart screening. A medical provider typically reviews the student’s medications, previous illnesses, injuries and general health, then checks vital signs and examines the heart, lungs, muscles, joints and other areas of the body.
The student and a parent or guardian complete the medical history portion of the UIL form. Questions about chest pain, fainting, unusual shortness of breath, a racing heartbeat and family history can be particularly important for identifying possible cardiac risks.
Parents should answer every question carefully and tell the provider about relatives who may have experienced cardiac arrest, cardiomyopathy or a serious rhythm disorder.
It’s important for parents to know information that might seem unrelated could help the provider recognize a problem.
“The first step is an appointment with a primary care doctor for a physical,” Bush said. “That is enough for most students. If a doctor detects something unusual or troubling, they may recommend an EKG.”
What does UIL require for 2026–27?
Under UIL’s statewide minimum requirements, students participating in sports and marching band must receive a physical before first participating in middle school athletics, and again before their first and third years of high school athletics.
Each year, the student and a parent or guardian must also complete a medical history form that asks about symptoms, family history and other potential health concerns.
Families must be given information about sudden cardiac arrest and the option to request an EKG in addition to the required physical.
The examination must be completed and signed by an authorized medical professional, and the required documents must be on file with the school districts before the student takes part in athletic activities.
When should a student receive an EKG?
An EKG records the heart’s electrical activity and can identify certain rhythm or electrical abnormalities that may not be discovered by listening to the heart.
During the test, small adhesive electrodes are placed on the chest, arms and legs and connected to a machine that records the heart’s electrical signals. The test is noninvasive and painless, does not send electricity into the body and can typically be completed within a few minutes.
“All of our University Health ExpressMed urgent care clinics perform EKGs. It can often be done at the appointment where the doctor or provider finds something of concern,” Dr. Bush said.
[Related: Are innocent heart murmurs in kids a cause for concern?]
Does an abnormal finding mean sports are over?
It’s important for students and their families to know: Finding a possible heart problem does not automatically end a student’s dreams of playing sports.
“I think that’s horrible,” said Dr. Bush. “The most important part of high school is to learn how to live in a community. You have to learn how to interact with other people in a positive way. I think that’s why team sports are so important.”
Dr. Bush said his response to the discovery of a child’s heart condition is to first recommend non-medical steps the patient and their family can take. He then considers medications and procedures when they are needed. He encourages families to make the coach or team leader an ally who is prepared to require limitations or activity modifications that will prevent medical complications.
“We’re in a time now where we understand the nature of the conditions. We understand the risks associated with them, and our job is to educate the families about those risks and work with them to bring those risks down. Sports are an important part of the student experience. Playing it safe is important, too.”
For sports physicals, families can go to one of University Health’s walk-in urgent care clinics or visit their family doctor.