Why heart conditions are no longer career-enders for Bronny James, many other elite athletes

Five months after going into cardiac arrest, Bronny James is preparing to return to the basketball court. A decade ago, his basketball career might have been over. What changed?

Bronny James warms up before USC's game against Gonzaga on Dec. 2 in Las Vegas. (AP Photo/Sam Morris)
Bronny James warms up before USC's game against Gonzaga on Dec. 2 in Las Vegas. (AP Photo/Sam Morris)

Shortly before USC faced Gonzaga on Dec. 2, the Trojans men’s basketball team emerged for pregame warm-ups. Players cracked jokes while unleashing a barrage of jump shots. Then a few of them dazzled the crowd with dunks as a Drake song blared in the background.

It was the sort of scene you might see before any college basketball game. Except that barely four months had passed since one player’s heart briefly stopped beating.

On July 24, during a morning training session with his USC teammates, Bronny James crumpled to the Galen Center floor without warning. A distraught witness attempted to convey the urgency of the situation to a 911 operator, crying out, “Listen, listen, listen, listen to me, OK? Get an ambulance here, now.”

Scanner traffic published by TMZ in July indicates that Bronny was unconscious at the time of the 911 call. The cardiologist who initially treated the oldest son of NBA legend LeBron James credited the USC medical staff’s “swift and effective response” for helping to prevent brain or organ damage due to oxygen deprivation.

The James family has revealed little about what caused Bronny’s sudden cardiac arrest except that it was the result of a congenital heart defect. That establishes only that Bronny was born with an unspecified structural heart abnormality that put him at a higher-than-average risk of cardiac arrest.

Not long ago, heart abnormalities such as Bronny’s were often career-enders for high-level athletes. Many cardiologists were quick to deny athletes permission to return to intense physical activity if they were even slightly more vulnerable to sudden cardiac death.

Now, the discovery of a heart abnormality is far less likely to force elite athletes into early retirement. Bronny himself has been cleared by his doctors for a full return to basketball and could make his college debut as soon as Sunday against Long Beach State.

What has changed over the past decade? Why are so many athletes returning to their sports, risks be damned in some cases? The about-face was set in motion by a cardiologist who has become a beacon of hope for elite athletes sidelined by heart conditions, one LeBron took Bronny halfway across the country to meet with earlier this year.

Giving athletes the choice

Michael Ackerman broke into sports cardiology at a time when the scars from two high-profile tragedies were still fresh.

In 1990, Loyola Marymount All-American Hank Gathers collapsed on the court and later died just months after being diagnosed with a heart condition. Three years later, Boston Celtics All-Star Reggie Lewis fell dead during offseason work under similar circumstances. The painful questions raised by those deaths created a climate of fear in the medical community. Many cardiologists didn’t want to risk having a patient suffer the same fate that Gathers and Lewis did.

“The dogma across the land was if in doubt, kick them out,” Ackerman told Yahoo Sports. “It was often no more than a 30-second conversation. ‘No, you can’t keep playing. Next question.’”

When Ackerman joined the Mayo Clinic in Rochester, Minnesota, in 2000, he got an up-close look at the mental health implications of that restrictive philosophy. Athletes diagnosed with heart conditions struggled with having the futures they envisioned for themselves ripped away in an instant.

“If you wanted to, you could measure the ruined lives, the trainwrecks, that we inadvertently created in cardiology with this default of disqualification,” Ackerman said. “We’ve all seen the kid who did not cope well and became suicidal. We’ve all seen athletes going from straight A's to getting C's and D's in school, well-adjusted kids who fall into depression and alcohol.”

Among those cautionary tales is a former top-100 recruit who was denied permission to keep playing for Tennessee after he went into cardiac arrest 14 years ago. Emmanuel Negedu then transferred to New Mexico after agreeing to get an internal defibrillator to go through daily heart rate monitoring and signing a waiver assuming all legal risk.

Ten games into his comeback, New Mexico administrators pulled Negedu aside and told him they couldn't risk allowing him to play for the Lobos anymore. The university said Negedu's internal defibrillator produced a reading that caused doctors to sideline him.

Years later, it still gnaws at Negedu that the choice of whether to keep playing was taken from him. To this day, he sees peers still playing professionally in the NBA or overseas and wonders, “What could I have been? What would I have done?”

"I wished that I would have died when that happened to me,” Negedu said. “I wished that I didn’t wake up. I’m here now. I’m living life. I have my kids. I have my wife. But for a long time, it was really tough.”

Hearing those types of stories inspired Ackerman to help lead the fight for change. He began to advocate for a more collaborative approach to treatment based on the needs and desires of the athlete-patient.

Today, Ackerman first asks athletes with heart conditions about “the two O’s” — is playing their sport optional to them? Or is it like oxygen? If the answer is oxygen, then Ackerman diagnoses the athlete as accurately as he can, explains how risky returning to a high-intensity sport could be and advises them about the treatment options available. Then it’s up to the athlete to decide how much risk to assume in pursuit of his or her dreams.

About 15% of athletes determine that the risk is not worth it, Ackerman said. The rest ask him to help them return to their sport in the safest way possible.

For years, Ackerman’s approach put him on an island among cardiologists. As recently as 2015, the official stance of the American Heart Association and American College of Cardiology was that “the level of importance that the athlete personally attaches to engagement in competitive sports should not be a deciding factor in formulating eligibility recommendations.”

As sports cardiology colleague Matthew Martinez put it, “Michael was speaking the truth, but not everybody was ready to hear it.”

Hank Gathers, one of only two Division I players to lead the nation in scoring and rebounding in the same season, tries to get up after collapsing during Loyola Marymount's West Coast Conference Tournament against Portland in Los Angeles, March 5, 1990. Gathers, 23, died later that evening. (AP Photo/Doug Sheridan)
In 1990, Hank Gathers collapsed during Loyola Marymount's game against Portland. Gathers, 23, died later that evening. (AP Photo/Doug Sheridan)

‘A wake-up call to the cardiology community’

Martinez himself was part of the first wave of converts to Ackerman's patient-centric philosophy.

The New Jersey sports cardiologist reevaluated his approach 15 years ago after he, in his words, “destroyed” a high school athlete by telling her she couldn’t safely keep playing her sport. He watched in horror as that created a rift between her and her closest friends and plunged her into depression.

“I thought, ‘That’s it. I’m not doing this anymore,’” recalled Martinez, now the director of sports cardiology at Morristown Medical Center. “'It doesn’t make any sense to me. I don’t like the way this feels. We’ve got to find a better way to do it.'”

Increased awareness of potential mental health issues is just one reason that many sports cardiologists have begun to embrace a return-to-play mentality. Better medications, implantable devices and surgical techniques have also accelerated the shift. So has the prevalence of emergency response plans at schools and AEDs (automated external defibrillators) at athletic facilities.

Then there’s the anecdotal effect of seeing high-profile athletes such as Shaquille O’Neal’s eldest son, Shareef O’Neal, and Manchester United midfielder Christian Eriksen return to their sports without incident after a diagnosis of a heart condition.

Ackerman has helped hundreds of high school, college and pro athletes manage their heart conditions and return to their sports. Many of those athletes came to him after being told by another physician that they couldn’t play anymore.

In 2018, University of Alabama doctors would not clear Jared Butler after a cardiac screening revealed that the incoming freshman had a milder version of the same heart condition that killed Gathers. Butler sought a second opinion from Ackerman, who worked closely with the Baylor coaching staff (following Butler's transfer) to help devise a monitoring system so that the future NCAA champion and NBA draft pick could continue to play basketball.

Ackerman did the same for Keyontae Johnson when the Florida star sought to resurrect his career more than a year after his heart stopped and he collapsed face-first during a game against Florida State in 2020. Doctors at Florida deemed the risk of a repeat cardiac arrest too high, but Ackerman's blessing carried considerable weight at Kansas State, where longtime Baylor assistant Jerome Tang had just been hired as head coach.

Last August, Ackerman, Martinez and a handful of other cardiologists published a study describing the experience of 76 Division I college and professional athletes who returned to their respective sports after being diagnosed with a heart abnormality. Only three athletes had a non-fatal cardiac event over an average follow-up period of seven years. Only one experienced such an incident while exercising. None of the athletes died.

Ackerman describes the study as “a wake-up call to the cardiology community that the old way of doing things is dead.” Martinez said he hopes the study encourages primary care physicians to send athletes to specialists to explore the opportunities available to them.

Asked if he worries he could face a lawsuit if an athlete he clears to return goes into cardiac arrest and dies, Ackerman admitted that’s “the elephant in the room.” He acknowledged that it’s a risk, but he said he has decided “you can’t practice medicine in a satisfying way if you’re going to look over your shoulder for a consequence.”

“Every one of our athletes knows full well that something could happen,” he said. “As we say over and over again, this is a non-zero risk proposition. It’s just, what’s your choice?”

Kansas State forward Keyontae Johnson (11) dunks against Oklahoma during the first half of an NCAA college basketball game in Manhattan, Kan., Wednesday, March 1, 2023. (AP Photo/Reed Hoffmann)
Keyontae Johnson's basketball career was put on hold after he suffered a cardiac event in 2020. He has since returned to the court, starred for Kansas State and been selected in the second round of the 2023 NBA Draft by the Oklahoma Thunder. (AP Photo/Reed Hoffmann)

'Mom, I'm going to play'

Inside a Milwaukee hospital room, the mother of a teenage basketball star struggled to console her son.

Jordan Glenn-Hawkins collapsed and lost consciousness after going into sudden cardiac arrest during a high school game on Jan. 9, 2021. The physicians who treated him told him he couldn’t return to basketball, that the threat of another exercise-induced cardiac incident was dangerously high if he kept playing a high-intensity sport.

“There’s always coaching,” Glenn-Hawkins' mother, Carlissa Glenn, gently pointed out.

“Mom, I’m going to play,” her son responded, not a hint of doubt in his voice.

For Glenn-Hawkins, basketball wasn’t just a path to a potential college scholarship. It had been his obsession ever since he was 2 years old, shooting from the staircase into a makeshift hoop fashioned out of a cardboard box. In middle school, he’d play pickup games with his neighbors until it was too dark to see the ball. By his junior year at Wisconsin Lutheran High, Glenn-Watkins had blossomed into a dynamic combo guard.

Basketball even monopolized Glenn-Hawkins' thoughts on the night that two quick-thinking nurses saved his life by rushing from the bleachers to administer CPR and shock his heart back into rhythm. One of his first memories after regaining consciousness is asking Carlissa from his hospital bed, “Mom, did we win?”

“That’s how much he loves the game,” Carlissa said with a laugh.

And that's why Carlissa couldn’t accept the advice of the Milwaukee doctors who forbade her son from playing basketball again.

In January 2021, Carlissa and her son traveled to Rochester, Minnesota, to seek a second opinion from Ackerman. Carlissa's goal, she said, “was to find someone who would allow Jordan to do what he loved but would make it as safe as possible.”

While scans and testing found nothing wrong with Glenn-Hawkins' heart, Ackerman knew that some sort of cardiac event had caused the teenager’s collapse. As a result, he recommended surgery to implant a defibrillator that could monitor Glenn-Watkins' heart rate and, if necessary, deliver an electric shock to restore a normal heartbeat.

That device did its job less than a year later. On Jan. 7, 2022, Glenn-Hawkins collapsed again in the middle of a high school basketball game. This time, the defibrillator detected an abnormally high heart rate and shocked his heart back into rhythm.

Doctors determined that Glenn-Hawkins hadn't eaten or drank enough that day and that the combination of dehydration and intense physical activity caused his heart to have to work unusually hard. Glenn-Hawkins returned to basketball again and is now one of the leading scorers for an Ellsworth Community College team ranked No. 9 in the latest NJCAA national poll.

Carlissa streams all of her son's games from her home in Milwaukee. She says she hopes he keeps pursuing basketball, but she admits that it's difficult for her to relax when he's on the court.

"As a parent, in the back of my mind, there’s that fear for me during every game," she said. "Even if he doesn’t have that fear, I do."

Two and a half years after Glenn-Hawkins and his mother first visited Ackerman, Bronny and LeBron were spotted leaving the Mayo Clinic in Rochester, Minnesota. The James family has since confirmed that Bronny received follow-up evaluations from Ackerman and Martinez. Both cardiologists declined to comment on anything Bronny-related, citing patient privacy laws.

Now, Bronny is on the cusp of joining the growing number of athletes who have returned to their sport after being diagnosed with a heart abnormality. He’s back at practice and ramping up his conditioning in hopes of making a return to the court later this month.

For Bronny, the decision to attempt to play basketball again was apparently an easy one.

As LeBron told reporters last week, “That’s his passion and his joy.”