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Sudden deaths of young athletes fuel the heart screening debate

by Olga Deshchenko, DOTmed News Reporter | June 28, 2011
From the June 2011 issue of HealthCare Business News magazine

There is more clarity on the conditions that trigger sudden cardiac arrests. In the United States, the most prevalent cause of sudden death among young athletes is hypertophic cardiomyopathy, an abnormal thickening of the heart muscle that’s often an inherited condition. According to a 2003 article in the New England Journal of Medicine, it accounts for about a quarter of all deaths among student athletes.

Other leading causes include congenital coronary abnormalities and arrhythmogenic right ventricular cardiomyopathy (ARVD), a rare inherited heart muscle condition.

When the media reports on a new sudden death incident, the news reignites the debate not only about whether all students should take part in a mandatory cardiac screening but also how in-depth it should be.

Across the U.S., a personal and family history questionnaire and a standard physical exam are the usual precursors to participation in team sports. Many parents and cardiologists also believe electrocardiograms and echocardiograms should be regular aspects of screening.

But when it comes to the effectiveness, feasibility and cost of a nationwide cardiac screening approach, experts remain divided.

ECG concerns
An electrocardiogram is a quick and painless test that can catch some of the common abnormalities that may lead to a sudden death. “Research shows that a well-read ECG can catch between 40 and 60 percent of the conditions that happen,” says Snyder.

And yet, the American College of Pediatrics, the American College of Cardiology and the AHA do not recommend ECGs to be a formal part of the screening process.
“The current position is that the screening really should focus on personal and family history and the physical examination, as a way of identifying athletes who should then get further evaluation,” says AHA’s Daniels.

Many experts believe that an ECG is not an efficient screening tool because it may miss some disease issues and indicate there’s a problem when there isn’t one. “Screening with an electrocardiogram is pretty controversial,” says Dr. Aaron Berman, chief of cardiovascular disease at Beaumont Hospital, Royal Oak in Michigan.

It’s not uncommon for athletes to have unusual ECGs due to changes in their heart because of intense levels of training, explains Berman, who also runs the hospital’s Healthy Heart Check Program for student athletes. “The fear is, that as many as 15 percent of kids who undergo a screening are going to be found with some kind of abnormality and then will be referred for additional testing,” he says. “There will be a lot of anxiety and expense associated with that.”

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