A Look at the Peverley Incident

Monday, the Jackets faced off against the Dallas Stars in Dallas. Just over seven minutes in, the hockey community witnessed a truly gut wrenching scene when Dallas forward Rich Peverley collapsed on the bench from what was later identified as a cardiac condition. The Union Blue is fortunate to know a Doctor who we’ve called on in the past to talk about medical issues to share perspective of what exactly happened during the moments of concern and chaos following Peverley’s issues on the bench.

Above and beyond this posting, the most important thing for all of us at The Union Blue is Peverley’s health and well being. We wish him the best of recoveries and are humbled with the lessons something like this shows us about what’s really important.

***Please note that this content represents one physician’s opinion. This article in no way presumes to know the specifics of Peverley’s condition, diagnosis or treatment and should not be considered as such. DO NOT attempt to perform any of the assessments or procedures outlined below, unless you also happen to be a medical professional***

1) What steps might have been taken when Peverley collapsed (and he was taken down the tunnel) i.e. how do you triage this kind of event?

If the person is unconscious, shake them to see if they are awake, look for breathing, and check for a pulse. If you don’t feel a pulse, immediately call for help, and then start chest compressions at a rate of 100 per minute. It was a good thing they brought him into the tunnel, as his family, teammates and kids watching didn’t need to see that, it’s very shocking. When help arrived they would have a mask for breathing, and an automated external defibrillator (AED). They alternate chest compressions with breaths, at a rate of 30 compressions to 2 breaths, which continue until the AED is attached. The AED prompts with instructions: it tells everyone to stop what they are doing, stop touching the patient, while it analyzes the heart rhythm. If it can be shocked, then it tells everyone to clear, then applies a shock to the heart to reset the rhythm. After being shocked they would check for a pulse, in this case they likely found one, as the Stars doctor said it only took one try. While this was going on, someone would have been inserting an IV, in case they needed to give him medications. This would be adrenaline, as there are some rhythms that can’t be shocked back normal (ie. a flatline, which cannot be shocked contrary to what you’ve seen on TV).

2) What advances in medicine may have helped contribute to ensuring Peverley was “fine”?

Maybe not necessarily a medical advance, but he was in a place where he was able to receive help immediately. The most important part was that he started receiving chest compressions very quickly, so he continued circulating blood. It also helps a lot that the Stars doctors were there and know all the details of his condition. However, even if they were playing in Columbus, the Blue Jackets team, with three doctors and the same medical equipment near the bench, would have been able to handle the situation with a similar outcome.

3) Any comment on the condition of a “quivering” heart (as described by the team doctor)?

The function of the heart is to pump oxygenated blood to vital organs and return deoxygenated blood to the lungs. It does this by pumping the blood at a regular, synchronized pattern. Imagine using a turkey baster: when you squeeze the rubber part, all the liquid drains out, and when released, more fluid is drawn in. The heart works in a similar way. The synchronized pattern is maintained through an electrical rhythm. In the case of atrial fibrillation, the top half of the heart (the atrium) quivers, so it neither fills or pumps effectively. Imagine the turkey baster again, only this time instead of fully squeezing it, you just made tiny little, rapid squeezes. You wouldn’t drain much from your baster, or draw any more in. The word quivering used here, is the description of those tiny little rapid squeezes. For a visual of this, check out this video:

Lots of people walk around with atrial fibrillation and they don’t pass out. They have to have their rate (how fast their heart beats) controlled with medicine. They also need to be on a blood thinner, so the blood that is staying still in the heart does not clot. At some point during the game, his heart went into a very dangerous rhythm, either ventricular tachycardia (rapid heart rate in the bottom half of the heart) or ventricular fibrillation (a quivering of the main contractile part of the heart). With either of these two rhythms, he would not have been pumping blood into his brain.

4) What kind of treatment might he have to undergo after this event or for this condition as a whole?

I don’t know why a young, healthy professional athlete has an abnormal rhythm. This question is best answered by addressing the cause of the abnormal rhythm. He could have an extra pacemaker, as normal hearts have two which maintain the rhythm. An extra pacemaker is like having a backseat driver, as it interrupts the signal between the other two pacemakers. The treatment for that would require surgery to eliminate the extra pacemaker.  Another potential cause for this would be that his two pacemakers are abnormal. Most of the time they function normally, but sometimes can go haywire. If this is the case, he may need a pacemaker implanted into his heart. There are two functions of the device, one could tell the heart each time when it should beat, or one that sits quietly and waits for an abnormal rhythm and shocks his heart (like the AED). The heart is INCREDIBLY complicated, but these are the two most likely situations. There are a myriad of combinations in terms of exactly what causes his abnormal rhythm and the specific cardiac event he suffered. Some of these can be treated to the point that he can play again. Other combinations would mean playing professional hockey would likely be too demanding heart.

5) Physical impact aside…any comment on the emotional impact of seeing a teammate undergo this kind of event?

 This is a very distressing situation to encounter. Unlike an injury, which no one wants but athletes expect, something like this is completely unexpected in someone this young, and can be very shocking. In most injury cases you SEE the injury, people know what to do and how to handle it. A player breaks his leg, they can help him off the ice, they know what needs to be done, when he’ll be back, etc. There is certainty around it. Even something as horrific as the Clint Malarchuk and Richard Zednik incidents can be understood like this. Stop the bleeding, stitch up the wounds, and they are probably going to physically heal. Here though, all the Stars (and Blue Jackets) were just totally helpless. Even further, when this happens, the person looks lifeless. Even when someone is unconscious, they still look alive. In this kind of situation, the person looks pale (as they are not pumping blood) and is totally limp. Even the treatment is unnerving. Chest compressions are violent and can break ribs. The person can be vomiting. Being shocked causes the whole body to contract and become limp immediately. This can go on for several cycles, even taking up to an hour. It is very fortunate that only one cycle was needed for Peverley. My heart goes out to Peverley and his family, his teammates, and anyone who witnessed this. I hope he has a speedy recovery and is able to return to the ice someday.

As we said at the beginning of this post, and in the Stars of the Night, science aside – this was a scary scary situation. Hockey may be the best sport for what happens off the ice even more so than what happens on it. We hope for a quick and full recovery for Rich!