Should high school athletes be screened for heart trouble before
taking to the practice field?
Once thought to be exceedingly rare, sudden cardiac death is far
more prevalent among young athletes than previously believed,
recent research has shown. In a policy statement published in the
journal Pediatrics last month, the American Academy of Pediatrics
estimated that 2,000 people under the age of 25 die from sudden
cardiac arrest in the United States every year.
While it can strike those who are sedentary, the risk is up to
three times greater in competitive athletes. According to some
experts, a high school student dies of cardiac arrest as often as
every three days. Only the most sensational cases make headlines,
said Darla Varrenti, executive director of the Nick of Time
Foundation, which promotes awareness of sudden cardiac arrest in
young people and provides free screenings. The condition received
worldwide attention in March when Fabrice Muamba, a star soccer
player in England, nearly died after suddenly collapsing in cardiac
arrest during a televised game.
Ms. Varrenti started her foundation six years ago after her son,
Nick, 16, a varsity athlete, died in his sleep after playing in a
game. In January and February of this year alone, 29 young athletes
went into cardiac arrest at schools across the country, Ms.
Varrenti said. Only four survived.
“There’s a lot of press when the cases are spectacular,” she
said. “But this happens all the time.”
Sudden cardiac arrest in a young person usually stems from a
structural defect in the heart or a problem with its electrical
circuitry. The most frequent cause, accounting for about 40 percent
of all cases, is hypertrophic cardiomyopathy, or HCM, a thickening of the heart muscle.
The problem is that those who are at risk are hard to spot.
Warning signs, like dizziness and shortness of breath, can be rare
or dismissed by young athletes used to overworking themselves.
But an electrocardiogram, or EKG, can
detect HCM and other potential causes of
heart trouble by looking for abnormal electrical signaling in the
heart. Though EKGs are not as thorough as imaging tests like an
echocardiogram, which shows a 3-D view of the heart, they are
cheaper and easier to conduct on a wider basis.
An EKG can cost as much as $150, according
to the American College of Cardiology. But many insurers will cover
80 to 100 percent of the costs, and in some areas, high schools
offer student athletes EKGs at deeply discounted rates.
Still, the American Heart Association does not support wide
screening. Under its guidelines, high school athletes get a
physical exam, which includes listening to the heart and a blood
pressure check, and fill out a questionnaire about personal and
family medical history. More extensive testing takes place only if
the student’s physical or history raises red flags.
For years, the argument against EKGs was that for something as
rare as sudden cardiac death, there is no sense in mandating costly
tests. EKGs can be unreliable, too, producing false-positive
results 20 percent of the time, critics say.
But that argument pivots on old data, including outdated numbers
on the prevalence of sudden cardiac death, and fails to take into
account improvements in the standards for interpreting EKG results, said Dr. Jonathan Drezner, an associate
professor of family medicine at the University of Washington and
vice president of the American Medical Society for Sports
Medicine.
Even physical exams that include extensive medical histories
typically fail to identify 60 percent to 80 percent of student
athletes at risk, Dr. Drezner said. Adding an EKG to the sports physical would flag many young athletes
whose heart defects would otherwise go unnoticed.
“No one is recommending you only do an EKG,” he said. “It really is the combined protocol of
history and EKG that provides the more
advanced heart screening that we should aim for.”
In a study published in 2010 in Annals of Internal Medicine, Dr.
Matthew T. Wheeler and colleagues at Stanford University found that
adding EKGs to sports physicals for young athletes would create “a
large benefit in a small number of individuals.” But they would
save enough lives to be considered cost effective, with a net cost
of roughly $89 per person screened.
Based on their analysis, however, Dr. Wheeler said that EKGs
make sense only for high school and college athletes — in children
and adolescents, the risk of sudden cardiac death is lower — who
compete in high-intensity sports like basketball, football and
soccer. (Low-intensity sports, he said, include golf and
bowling.)
“We are not advocating this as a mandatory test for all students
or all athletes,” said Dr. Wheeler, a fellow in cardiology at
Stanford Medical School.
Some experts think the time has come for thorough heart
screenings for all young athletes. Researchers at the Texas Heart
Institute are even looking at the prevalence of heart abnormalities
in middle-school students and the feasibility of complete
screenings, combining EKGs and imaging tests.
The goal of the project, which is financed through a $5 million
private grant, is to screen 10,000 students in Houston middle
schools, said Dr. Jim Willerson, the lead investigator and
president and medical director of the Texas Heart Institute. “If we
save even one life, it will be worth it,” he said.
Dr. Willerson said his hope was that school districts elsewhere
would start to consider detailed screening of children “before they
are involved in competitive athletics and probably even as they
enter school.”
In the meantime, hundreds of groups like Ms. Varrenti’s have
made it their mission to provide free EKGs and heart examinations
to young people at community screenings around the country. Parents
who are interested in a heart screening can reach out to their
family doctors, or find out about free screenings in their area at
Web sites like parentheartwatch.org.
“You can either open the dialogue with your pediatrician or look
into free screenings,” Ms. Varrenti said. “No one should go through
what our family went through.”
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from new york times