Stewart Krug, of Pike Creek, holds a photo of his son, Matt, who died two weeks after his 16th birthday.  [picture removed]

From the time he could walk, Matthew Krug was always on the move.

He swam breast stroke for the Arundel Swim Club and McKean High School. He played roller hockey at the YMCA. He shot hoops with friends.

He seemed like every other teenager his age -- a nonstop swirl of carefree energy contained in a lanky, 5-foot-9 frame.

But there was a problem with his heart that nobody knew.

While playing basketball at the pool on the afternoon of July 6, 2001, Matt collapsed.

He went into sudden cardiac arrest, brought on by an undiagnosed case of hypertrophic cardiomyopathy, also known as an enlarged heart.

Although three lifeguards immediately performed CPR on him until paramedics arrived, he suffered extensive brain damage. When emergency personnel arrived, it took three attempts with a defibrillator to get his heart restarted.

He spent 12 days in a coma at the Alfred I. duPont Hospital for Children in Rockland. He never regained consciousness.

On July 18, two weeks after turning 16, Matt died.

An undiagnosed ailment

Hypertrophic cardiomyopathy is the leading cause of sudden cardiac death in young people, said Dr. Bradley Robinson, a pediatric cardiologist at A.I. duPont Hospital. Coronary abnormalities are the second-biggest cause.

Although most people don't know hypertrophic cardiomyopathy by name, they've heard about young, seemingly healthy athletes dying on football fields, basketball courts and after running track. These frightening, out-of-the-blue types of deaths are why hypertrophic cardiomyopathy is considered a "silent disorder."

The condition, believed to affect about 1 in 500 people, according to some estimates, causes the heart muscle to thicken. The heart must then work harder. It's caused by a congenital abnormality in a little more than 50 percent of cases, but the rest of the time the cause is unknown.

In people with hypertrophic cardiomyopathy, the muscle fibers in the heart are not normally arranged, Robinson said. In most people, muscle fibers are found in parallel arrangement. With hypertrophic cardiomyopathy, the fibers are in "myocardial disarray," he said, meaning they don't line up.

This disorder causes the thickening in the heart walls, usually in the septum, the dividing wall between the left and right sides of the heart. As a result, people with the condition are more susceptible to arrhythmia, or irregular heart rhythms.

Matt's family didn't find out about his condition until after he went into cardiac arrest. But before that there were signs, said Matt's father, Stewart Krug.

A couple of months before his death, Matt developed a habit of pushing in on the center of his chest with his hands. Krug noticed and asked his son about it. "Matt couldn't explain why it hurt," said Krug, of Pike Creek. "He said it felt a little tight."

In late spring, a doctor examined Matt with a stethoscope and didn't find anything. That's a common occurrence in patients with hypertrophic cardiomyopathy, Robinson said, because murmurs -- abnormal heart sounds -- aren't audible all the time.

Robinson said the most common symptoms of hypertrophic cardiomyopathy are fainting while exercising or feeling chest pain upon exertion.

Electrocardiograms, which record the electrical activity of the heart, and echocardiograms, which create a moving picture of the heart, can be used to diagnose hypertrophic cardiomyopathy.

Unfortunately, Matt's doctor didn't send him for further testing, his father said, which could have uncovered his condition.

Working to honor Matt

Stewart Krug doesn't want anyone else to experience what Matt did. After his son's death, Krug created the Matthew Krug Foundation (accessible at www. matthewkrugfoundation.org) to provide cardiac health education through screenings and awareness.

Krug has worked with the state's Office of Emergency Medical Services to have automated external defibrillators, also known as AEDs, put in public places, including high schools, for cardiac emergencies.

On Nov. 9, the foundation will hold an AED demonstration and hand out information at Lake Forest High School in Felton in conjunction with the school's wellness center.

Krug also has worked with other parent organizations to increase access to cardiac screenings. One of his goals is to get students athletes' sports physicals to require at least an electrocardiogram, if not an echocardiogram. All students who play school-sanctioned sports must have physicals in order to play.

"We think kids are all healthy at that age, so we don't recognize the symptoms," Krug said. "Almost immediately after this happened to Matt, I said, 'I don't want this to happen to other kids.' "

Krug admits it's a challenge to get people interested in cardiac screenings because many believe there are too few deaths from sudden cardiac arrest, though about 7,000 young people die annually, according to the American Heart Association.

He also has heard the argument that electrocardiograms and echocardiograms are expensive tests to single out a few people with the condition.

Although young people are at the biggest risk of dying from sudden cardiac arrest, they are sometimes the hardest to convince to be screened, Krug said. They worry a bad test result will keep them from playing a sport they love, ignoring the fact that they could die as a result of an undetected heart problem.

People who are diagnosed with hypertrophic cardiomyopathy can use medication such as beta blockers to keep the condition under control. In some cases, restrictions on exercising and implantable defibrillators also are used.

In the summer, five years after Matt's death, Krug made a donation to the Arundel Swim Club in memory of his only son. His hope was that the next time an emergency like Matt's arises at the pool, the outcome will be better.

He donated a portable AED.

Contact Kelly Bothum at 324-2962 or kbothum@....

WHAT IS SUDDEN CARDIAC DEATH?

Sudden cardiac death, also called sudden cardiac arrest, is death resulting from the loss of heart function.

When sudden death occurs in young adults, heart abnormalities such as cardiomyopathy are likely causes. Adrenaline released during intense physical or athletic activity often acts as a trigger for sudden death when these abnormalities are present.

Brain death and permanent death start to occur just four to six minutes after someone experiences cardiac arrest. Cardiac arrest is reversible in most victims if treated within a few minutes with an electric shock to the heart -- called defibrillation -- to restore a normal heartbeat.

A victim's chances of survival are reduced by 7 percent to 10 percent with every minute that passes without defibrillation. Few attempts at resuscitation succeed after 10 minutes.

Source: American Heart Association

WHO SHOULD GET TESTED FOR HYPERTROPHIC CARDIOMYOPATHY?

• Anyone with a family history of sudden cardiac death or who has a family member who died when younger than 50.

• Anyone with a history of Marfan syndrome, an inherited connective tissue disorder. People with Marfan typically are tall, thin and have longer fingers.

• Anyone who has fainted or felt chest pain while exercising or during exertion.

Source: Dr. Bradley Robinson, Alfred I. duPont Hospital for Children