Before we all even had a chance to learn to pronounce Star Lotulelei's name, a heart condition detected during the medical testing at the NFL Scouting Combine in Indianapolis may have derailed his career. Teams and fans alike rushed to figure out what a low ejection fraction means for the player.
Let's take a look at some key questions surrounding this situation:
What Does "Low Ejection Fraction" Mean?
I spoke with Dr. Robert Kloner, the director of research at the Heart Institute at Good Samaritan Hospital in Los Angeles, about the known information.
Dr. Kloner explained that the low ejection fraction refers to the amount of blood being pumped out of the heart. This is a laboratory finding in an echocardiogram, not a condition in and of itself.
The question now is what is the underlying condition that resulted in this.
Lotulelei's agent, Bruce Tollner, says that he has been told it could be the result of Lotulelei's recent weight loss. Dr. Kloner told me that there were several possible causes, ranging from a virus to a congenital defect. It could also be due to a more serious condition, like cardiac hypertrophy, or even the result of a past heart attack.
All of this can be found with more advanced testing. Lotulelei is headed back to Utah, where he will have more advanced tests, and those results will be shared with interested teams when available.
(For more technical information on the condition, read this article from Bleacher Report's Dave Siebert.)
How Did He Play With This Condition?
The question of function vs. finding is one that many teams are coming to terms with in the case of Jarvis Jones, whose spinal stenosis diagnosis is causing a lot of issues despite his high level of play. It would surprise most that Lotulelei could have played at such a high level at Utah and before if this was a chronic condition.
The major symptoms of a low ejection fraction are fatigue, shortness of breath and arrhythmia. Remember, Lotulelei did not complain of any symptoms; this was found as the result of a standard test given to all participants. Lotulelei's weight has been questioned, but there are no signs that he was fatigued or in any danger during the past season at Utah.
Dr. Charles Orr, a cardiologist with St. Vincent's Hospital in Indianapolis, explained that one of the things he would want to see is a previous echocardiogram.
"It would likely be in his entrance physical," Orr suggested, "especially since he was transferring into a large program. The comparison would be the first thing I would want to see."
What Does This Do to Lotulelei's Draft Position?
B/R's draft guru, Matt Miller, has spoken highly of Lotulelei, telling me that he was "a definite top five pick."
Teams like Jacksonville and Oakland, with picks two and three in the draft, respectively, were watching him closely. Of the teams I was able to speak to, none have "red flagged" Lotulelei yet. They want to see the results of his tests later this week.
If Lotulelei is cleared by later tests, the normal period for recovery is variable.
"It can be anywhere from a couple weeks to a couple months," Dr. Kloner explained, "though it could be easily tested. They could also do a stress test, where they could see how his heart responds to activity."
Scouts would definitely want to see him at Utah's Pro Day in a couple weeks, but it is unclear now if that would be possible.
The psychological effect on teams due to this condition is huge, even if cleared by doctors. The consensus opinion is that as long as Lotulelei is cleared and the abnormal result adequately explained, his draft position should not fall far, if at all.
Is the "Cutting Weight" Excuse Just Spin?
Dr. Orr thought it was possible. "Simple blood tests would tell you a lot about things like electrolyte levels and such," he told me.
He also raised the issue of diuretics, drugs that force fluid out of the body. They can cause rapid weight loss, but also have some possible side effects. They are banned by the NFL and would be detected in the drug screens that Lotulelei took in Indianapolis.
The more likely causes, such as a virus or high blood pressure, are easy to check and tend to be easily correctable either through time or medication. We'll need more information to know whether or not Lotulelei's long-term and short-term weight loss contributed to this finding.
Did Lotulelei Fail His Medical?
Players do not pass or fail medical exams at the combine. They are exhaustively checked, as noted in this recent article by Dr. Jene Bramel, but the results are open to interpretation. What happened with Lotulelei is that the abnormal exam resulted in him not being allowed to participate in the physical portion of the combine.
In Indiana, all students that want to play interscholastic sports are required to undergo a cardiac test. The law, named for a top basketball recruit that died on the court as a result of an undiagnosed condition, requires a simple screening exam. While most will pass this test, those who do not are referred for more advanced exams. If a player passes those, he is cleared to play. This is much the same path that Lotulelei will take in his upcoming tests.
None of the doctors I spoke with felt that Lotulelei was in physical danger, but also recommended against physical activity until more tests could be run. The combine did the smart thing in holding Lotulelei out, but many should follow in the NFL's footsteps, especially at the youth level.