To his teammates, Ronald Rouse was known as “the big guy with the big heart.” On Friday night, his big heart killed him.

With 3:39 left in the second quarter of their homecoming game against Crestwood High School, the 6-3, 320-pound Hartsville High School lineman came out of his defensive stance and called timeout. He collapsed suddenly as he tried to walk off the field.

According to Darlington County School District spokeswoman Audrey Childers, team doctors and athletic trainers rushed to the fallen lineman’s aid. The medical team revived him, but he collapsed a second time. The physicians and athletic trainers used a defibrillator to try to start his heart until an ambulance arrived.

Ronald Rouse was soon pronounced dead at a nearby hospital.

In the following days, Darlington County Coroner J. Todd Hardee announced that the autopsy revealed Rouse died from “a fatal sudden cardiac arrhythmia resulting from a congenital enlarged heart.”

Cardiomyopathies, such as the condition Hardee reportedly found in Rouse, are conditions where the heart muscle is enlarged but the heart itself becomes weaker. Over time, its ability to pump blood can decrease. Abnormal heartbeats (arrhythmias), or even heart failure, can result.

News of the Hartsville star’s death shocked the nation. Many people have been surprised that a condition that could suddenly kill a high-level athlete could go undetected throughout his life.

Unfortunately sudden cardiac death is more common among young athletes than most realize. Different studies place the incidence between 1:25,000 and 1:200,000 athletes per year. Cardiomyopathies make up some of the common causes of sudden cardiac death in young athletes.

Rouse apparently had not exhibited symptoms prior to his collapse and death. Specific medical facts in his case have not been released. It seems likely that if an electrocardiogram or other test had revealed his condition, he would have been restricted from sports participation.

The arguments for and against mandatory cardiac screening for young athletes are beyond the scope of this column, and I have discussed that concept previously. But hopefully this tragedy can raise awareness of the importance of pre-participation physical exams (PPE’s).

When most athletes think about PPE’s, they remember hours spent standing in different lines at their schools waiting to be checked by different medical professionals. Or they think of the dreaded form they must complete before they can play.

What athletes and their parents need to remember is that these exams can save their lives.

While cardiomyopathies and other heart conditions can remain silent until fatal events occur, patients can have symptoms such as chest pain, shortness of breath, or feelings of a racing heart. Athletes must discuss these symptoms with their doctors.

Many of these fatal cardiac conditions are passed on through families. Often teenagers do not know all of the medical details of illnesses and deaths among family members. Parents should complete the medical history component with their children to improve accuracy and alert the examiners to the possibility of a cardiac abnormality.

Finally, whenever possible, athletes should see their regular pediatricians or family doctors for the PPE’s. Thorough histories and physical exams in quiet offices with doctors familiar with the athletes could likely increase the chances of detecting abnormalities and initiating appropriate cardiac workups.

Shortly after the announcement of his death, flags in Hartsville were lowered to half mast in Rouse’s honor. Principal Dr. Charlie Burry released a statement describing him as “a big, friendly guy who enjoyed school, playing ball, and life. He was also an intelligent young man, whose perspective on life had some unusual depth for someone of his age.” Hopefully his death at an early age can help to prevent tragedies like this in the future.

For more information about football injuries and other sports medicine topics, please go to Dr. Geier’s blog at drdavidgeier.com.