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The debate over heart screening for athletes

Friday, August 27th, 2010



The death of a standout Philadelphia high school basketball player has renewed the debate about how to detect heart trouble in competitive athletes.

It’s not clear yet, what killed Prep Charter High School student Akhir Frazier, but his mother reportedly said he suffered from a thickening of the heart.

John Murphy is a pediatric cardiologist at St. Christopher’s Hospital for Children in Philadelphia. He says the heart trouble that leads to sudden death in athletes often runs in families.

Murphy: If any doctor examining a young person — who’s going to be playing competitive athletics — comes up with a history of other family members who have had syncopal, or fainting episodes with exercise, or worse, sudden death, they should be screened in a rather formal way.

Some sports medicine experts have argued that all competitive athletes should receive an electrocardiogram to measure electrical activity in the heart and rule out problems. Others say mandatory screening would be impractical and costly.

Experts worry that requiring an ECG for all student athletes would lead to many false positives. Critics say the U.S. system doesn’t have enough pediatric specialists to read the tests or interpret the results.

The American Heart Association recommends that all student athletes get a yearly medical exam and talk to their doctor about any family history of heart problems.

Dr. Barry Maron, with the Minneapolis Heart Institute Foundation, leads a national registry that tracks sudden deaths in athletes.

Maron: Limiting a national, mandatory program to competitive athletes is discriminatory. There’s no other word for it. These genetic cardiovascular diseases that are at question do not cause death limited to athletes, they occur in non-athletes more commonly in fact.

Maron said Italy is the only country that includes a regular ECG screening testing in its required exam for athletes.


4 Comments

  • Connie says:

    Thank you, Kathy, for your well-spoken remarks. It is only a matter of time until the ECG and echocardiogram are a normal part of youth physicals. Let’s quit complaining about it and find ways to do it that are more efficient and economical. The lives we save make it worthwhile.

  • Kathy says:

    Dear Taunya,

    I just read your article “The Debate over heart screening for athletes” and felt like I need to respond. As you, I have read what the “experts” have said against doing EKGs on physically active young adults. For each expert you find that say we shouldn’t do EKGs, I will find you 2 that say we should do them.

    I have been involved with a screening program outside Chicago, started by Dr. Joseph Marek called Young Hearts for Life. This is the largest screening program in the United States. So far we have screened over 47,000 high school students free of charge. There have been over 800 students that have required further cardiac follow up.

    I think the parents of the boy who needed open heart surgery for a coronary anomaly (which we found through our screening) would disagree with your experts who say we shouldn’t do screenings. He left last week for college. He has a bright future.

    Maybe your experts should talk with the Dad who’s son was diagnosed with Hypertrophic Cardiomyopathy (HCM) because of our screenings. Because this condition is genetic, the daughter was tested and also found to have HCM. Both children now have a chance at a full life.

    Another story you might be interested in is the girl who was found to have Long QT and now has a defibrillator. All because of Young Hearts for Life screening program. I could go on with more stories of the other 135 students diagnosed with Long QT or maybe the 77 students who were diagnosed with Wolf Parkinson White Syndrome because of our screenings. Many of them have had a surgical procedure called an ablation and have now returned to playing sports. I could give you hundreds of examples of why screenings work.

    One of your points that you say your experts make is the false negative rate. Our false negative rate is in line with what they find in Italy. There they have decreased the rate of sudden death in young adults by 89%. Don’t our children deserve the same?? As far as the false negative results being a reason to not screen: How many of us woman have had a false reading on our mammogram? Pap Smear? Do we stop doing them? Are we worried until it is cleared? Absolutely, but we are relieved. We don’t stick our heads in the sand and say we won’t do it if we can get a false reading. The consequence of not doing these tests are too great.

    You say, “Critics say the U.S. system doesn’t have enough pediatric specialists to read the tests or interpret the results.” I’m sorry to put your critics down again, but this is a real stupid thing for any physician to say!!! Any physician can learn to read an EKG. Dr. Marek has read most of the 47,00 EKGs for Young Hearts for Life. He is not a pediatric cardiologist, but had probably read more EKGs and knows more about EKGs of high school students than anyone else in the United States. Dr. Marek has recently conducted a course teaching other physicians on how to read EKGs of this age group. I think most physicians are able to learn this. When open heart surgery came out, did we not do it because only a few doctors who knew how to do it? What about angioplasty? Now most cardiologist and cv surgeons do these procedures.

    Solutions to problems are never found by saying how we can’t achieve a worthy goal, but rather by asking how we can? Until we change this mindset, we will continue to unnecessarily lose too many of our precious youth to potentially preventable causes of sudden death.

    Thank you for listening,
    Kathy

  • Darren says:

    Italy does do screening on all of their athletes. They have reduced the incidents of death from sudden cardiac arrest by 89%.

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