THURSDAY, Sept. 9 (HealthDay News) — Most teenagers think
they’re invincible, and that goes double for talented teenage athletes.
They’re young, immortal, at the top of their game, the envy of their
friends.
So when news hits that an apparently healthy, high school or college
athlete has dropped dead in the midst of playing his or her favorite
sport, millions of parents get understandably anxious.
The uppermost question becomes: Should my child be screened before
participating in sports? What tests are needed? And how can we be sure
that he or she is truly healthy enough to compete?
Everyone agrees that a medical checkup before participating in sports
is crucial. But the agreement seems to stop there. At the core of the
conflict over further testing is how extensively young athletes’ hearts
should be tested before they’re cleared for athletic participation.
“I think everyone should have a doctor who evaluates them, and the
doctor should know the child is going to be participating in athletics,”
said Dr. Paul Thompson, the director of preventive cardiology at Hartford
Hospital in Connecticut, who helped write a joint position statement in
2007 from the American College of Sports Medicine and the American Heart
Association.
That statement recommends cardiovascular screening for high school and
college athletes before they start participating in athletics and at two-
to four-year intervals. The screening should include a family history, a
personal history and an exam “focused on detecting conditions associated
with exercise-related events,” according to the groups’
recommendation.
But, there’s more: “The AHA does not recommend routine, additional
noninvasive testing such as a routine EKG [electrocardiogram, which
assesses the heart's electrical rhythms].”
The American Academy of Pediatrics seems to agree. “Every athlete
should have a thorough history [taken] from the athlete as well as the
athlete’s family,” explained Dr. Reginald Washington, a pediatric
cardiologist and chief medical officer at Rocky Mountain Hospital for
Children in Denver and past chairman of the academy’s committee on sports
medicine and fitness.
The doctor should ask about any chest pain and dizziness, and whether
the athlete has ever passed out or experienced a racing or unusual
heartbeat, Washington said. The physician should also ask if the athlete’s
parents have had early heart disease, before age 55 for a man and 65 for a
woman. And the physical exam, he said, should be thorough and include
listening to the heart, taking blood pressure and feeling the pulse.
“If all of that is normal and the family history is normal, no further
tests need to be done,” said Washington, echoing the academy’s stand.
But others disagree strongly, calling for universal and extensive
testing of all young athletes to avert future tragedy.
Heart experts from Johns Hopkins Medicine in Baltimore contend that
both an EKG and an echocardiogram — which is an ultrasound that measures
heart size, pumping function and checks for faulty heart valves — are
crucial to detect early signs of heart defects in young athletes because
neither test alone will catch all potential problems.
In testing 134 high school athletes competing in the Maryland state
track and field championships in 2008, for instance, no life-threatening
heart defects were found but blood pressure abnormalities that required
further testing and monitoring were detected in 36 athletes, some by EKG
and some by echocardiogram, the Hopkins doctors reported at an American
Heart Association session in late 2009.
Testing in 2009, according to a Hopkins report, found a serious heart
valve disease in one track-and-field athlete and another with an
undiagnosed heart condition that could require a transplant in the future.
Neither athlete had reported any symptoms.
“If you are going to screen, it has to be comprehensive,” Dr. Theodore
Abraham, an associate professor at Hopkins’ School of Medicine and its
Heart and Vascular Institute, said in a prepared statement.
Other studies have found pros and cons to extra screening.
For instance, Harvard researchers who looked at 510 college athletes
found that screening with a history and physical exam alone has an overall
sensitivity of 45.5 percent, meaning it would find existing problems in
about 45 of every 100 athletes screened. But adding an EKG to the
screening boosted it to more than 90 percent.
However, the EKGs were also linked with a false-positive rate —
suggesting a problem when none existed — of nearly 17 percent, according
to their report, published March 2 in the Annals of Internal
Medicine.

A separate study in that issue, on the cost-effectiveness of such
screenings, reported that adding EKGs to screenings of young athletes
saves two years of life per every 1,000 athletes, at a per-athlete cost of
$89.

Screening policies differ from region to region across the country. In
Houston, for instance, athletic trainers at 10 high schools are using
laptop systems to give young athletes EKGs, and a doctor in the city has
launched a program to provide heart screening to all sixth-graders,
eventually hoping to screen all sixth-graders in Texas.

But there are downsides to such universal screening, others say.

“About 10 percent of kids who get EKGs are thought to have something
the matter with them by the EKG,” Thompson, the Connecticut doctor, said.
“That drives additional testing, and nearly all don’t have anything
wrong.”

The problem, he said, is not just wasted health-care dollars but the
anxiety caused by additional testing, for athletes and their parents.

Thompson said he is not oblivious to parental worry or to the sad
reality that some athletes die unexpectedly each year.

“Every single one of these deaths is an incredible tragedy,” he said,
adding that he will do extra testing if parents are very worried. “But
when people have looked at this, the death rate in the U.S. is about one
in every 250,000 athletes. There is not really conclusive research to show
[extensive testing] saves lives.”

Also, in mass screenings — where kids line up and are screened
quickly — accuracy may suffer, said Washington, the Denver pediatric
cardiologist. “A good, thorough ultrasound should take a half-hour,” he
said. “If you line up all the kids [at a school or on a team] to have a
portable ultrasound, you will miss some of these subtle
abnormalities.”

But Sharon Bates, a parent who founded the Anthony Bates Foundation
after her athlete son, Anthony, died unexpectedly in 2000 and was found to
have had an enlarged heart, disagrees with the arguments against mass
screenings.

Even if a problem picked up is minor, she said, you have a right to
know, and it needs to be addressed.

Bates’s son had passed the typical pre-athletic physical with flying
colors, she said, yet he still had a major cardiac problem.

Her Phoenix-based foundation promotes universal screenings for all
youth, not just athletes, she said.

As Abraham said, “What is the price for a single life?”

More information

The Nemours Foundation has information for kids on sports physicals.