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Playing it safe

Ortiz sent to MGH for more cardiac tests

OAKLAND, Calif. -- Red Sox majority owner John W. Henry, who has had to deal with an irregular heartbeat ``for many, many years," said he has spoken with slugger David Ortiz, who flew back to Boston last night for additional testing on his heart, and said the club has ``every reason to believe he will be fine, but that is for the doctors to ascertain and determine the cause.

``Yes, I am quite sensitive to irregular rhythms and have friends who have the same issues," wrote Henry, who has a condition known as atrial fibrillation, in an e-mail last night. ``They are more common than most people know."

The decision for Ortiz to return to Boston was made after he experienced palpitations before Monday night's game and was scratched from the lineup, according to a statement attributed to Red Sox medical director Thomas Gill and released by the club yesterday. Ortiz flew by private plane into Hanscom Air Base in Bedford with injured teammates Manny Ramírez and Wily Mo Peña, along with pitcher David Wells, who is scheduled to start Friday night's game at Fenway Park.

Ortiz was admitted last night to Massachusetts General Hospital, a club spokesman said, for several days of testing under the supervision of Sox internist Dr. Larry Ronan. Ortiz was kept for observation at Mass. General Aug. 19, after first complaining of the symptoms during that weekend's series against the Yankees.

Ortiz, addressing his condition last Friday before the team's game in Seattle, attributed the condition to stress, sleeplessness, and dehydration, and said he was feeling considerably better. But according to manager Terry Francona, he reported experiencing similar symptoms in Oakland Monday afternoon, and after meeting with Francona, general manager Theo Epstein, and team trainer Paul Lessard, it was decided he should return to Boston.

``This comes down to health," said Francona during his daily session with reporters, which yesterday also was attended by Epstein. ``However [doctors] feel about him, he has to know he's fine. We'll gladly put him in the lineup but not until we know we're not going to jeopardize his life.

``We really don't feel like he's going to keel over. He was tested the other night. A lot of people have these things. [But] we can't chance this. No way."

Ortiz leads the American League with 47 home runs and 121 RBIs, and on an otherwise disastrous trip for the team, he had three home runs and a double while scoring six runs and knocking in four. Despite his first reported episode with an irregular heartbeat, he played in all five games of the Yankee series Aug. 18-21. Monday night's game was the first missed by Ortiz because of his condition. He has served as the Sox cleanup hitter in 126 of the team's 132 games.

Red Sox outfielder Gabe Kapler said he saw nothing in Ortiz's recent behavior to suggest that he was having a recurrence of his condition.

``Absolutely not," Kapler said. ``[He was in] good spirits. Tons of energy. Normal Ortiz. He played well, obviously. No, I saw nothing. In fact I was really surprised to hear he needed to get more tests done. He was normal David."

Indeed, Ortiz was in the clubhouse before Monday's game, laughing and joking with staff and teammates about his involvement in the team's fantasy football league. ``They put me in charge of the Dominican operations," he loudly complained with a smile. ``There's no football players in the Dominican."

Third baseman Mike Lowell, like Kapler, detected nothing unusual in Ortiz's behavior.

``I don't even know how it started," Lowell said. ``Did he say he felt something in his chest? That's when baseball takes a back seat. We love him, he's our MVP and everything, but we're talking about things on a different scope when you're dealing with that.

``That has to be a priority. We can't, just because we're in a critical stretch, put him on the field and have something happen."

Pitcher Curt Schilling also expressed his concern for the welfare of Ortiz, widely considered a front-runner for the league's Most Valuable Player award.

`` `Disarray' is the only word I can use that kind of fits where we're at," Schilling said of the team's recent struggles, a stretch in which it has lost 11 of 13 to all but fall out of playoff contention. ``But there are a lot bigger issues than fielding a competitive nine-man team. It's bigger than wins and losses.

``There are a lot of personal things going on that are dragging on us more than winning and losing games. I'm as concerned [about Ortiz] as you would be if one of your close friends was sick. I don't pretend to know the issues behind the why and how. I just know how I want it to end up."

Ortiz is expected to undergo an ultrasound test known as an echocardiogram, and blood tests, including those seeking indicators of thyroid disease, along with stress tests. Doctors may also check for heart murmurs, high blood pressure, and Marfan syndrome, a disease of the aorta. They may also quiz Ortiz about any shortness of breath, episodes of passing out, and family history of cardiac disease.

``A lot of times they don't find the cause," said Dr. Kevin Harris, a cardiologist at the Minneapolis Heart Institute who has done considerable research on professional athletes and heart problems, last year making a presentation to Major League Baseball medical personnel at the winter meetings.

To aid in that search, Ortiz could be required to wear a monitor so doctors can evaluate future episodes. ``There are so many zillion kinds of cases, and so many that are totally benign," said Dr. Deeb Salem, cardiologist and chief of medicine at New England Medical Center. ``But the times you have them, even the benign ones, can be bothersome.

``We give some patients a little monitor. It's simple technology. They wear it a few weeks, if they feel any symptoms, they can go to a telephone with the gizmo, and within seconds a doctor can have an EKG."

Salem said the stress cited by Ortiz could indeed have caused the irregular heartbeat. ``Anything that causes stress can cause a lot of adrenaline, which stimulates the heart," he said.

Asked what risk Ortiz might face if he continued to play, Salem said, ``Some irregular heartbeats have zero risk, that it wouldn't make any difference [if he played]. But other certain patterns, there would be risk involved. I think the most important question to ask him is whether he passed out or was close to passing out. If no, then he's in a far lower risk group."

``In terms of heart arrhythmias," Harris said, ``we usually break them into life-threatening ones, and more benign ones like atrial fibrillation. While atrial fibrillation isn't usually life-threatening, it can be a nuisance. For a professional athlete, it would definitely impair performance."

Harris is co-author of a soon-to-be-published paper on how well professional sports teams screen for heart problems. ``Major League Baseball in particular tends to give a fairly complete evaluation of its players," he said. ``The American Heart Association has a series of recommendations, and Major League Baseball does a better job than other sports of screening."

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