By Dev K. Mishra, M.D., President, Sideline Sports Doc
There have been 3 recent well-publicized cardiac arrests in elite level athletes. Norway’s Alexander Dale Oen, the defending world champion in the 100m breaststroke was found dead at a team training camp. Piermario Morosini, an Italian footballer for Livorno (an athlete who had likely been screened in the preseason for heart problems…) died while on the pitch. And miraculously, Bolton’s Fabrice Muamba was successfully resuscitated after cardiac arrest during an EPL match.
Sudden cardiac death can-and does-occur in young athletes too. A recently published policy statement by the American Academy of Pediatrics estimated that 2000 people under the age of 25 die from sudden cardiac arrest in the United States each year. How many of those young people were screened for heart problems? What screening method is best? Lost in the debate about screening is one point that concerns me: many club sport athletes have no requirements for preseason physical exams and might escape without any screening at all.
Screening methods are not perfect, but improving
“Screening” means that a large group of individuals are evaluated in some fashion. Those found to be at risk for a condition are restricted from play, appropriately counseled, and treated for the condition. We screen for concussion risk, heart risk, asthma, orthopedic conditions, etc. The most common method currently in use for young athletes in the United States is the preseason physical exam. A recent New York Times article presents some interesting background, and I encourage you to take a look at it. Is there a better way to reliably screen young athletes for potential sudden cardiac death?
An electrocardiogram (EKG or ECG) is a test that evaluates the electrical activity of the heart. When used in conjunction with the preseason physical exam and questionnaire the EKG can significantly increase the power of the evaluation in detecting potential heart problems. Unfortunately, as seen by the death of the young Italian footballer, even the best screening methods are not perfect. There is debate about the cost-effectiveness of these screening procedures. There is also some debate that screening will lead to “false positives” that would unnecessarily exclude young athletes from sport participation. It’s also likely that in the near future we will have genetic testing available to screen for some of the most common causes for sudden cardiac death. The question of the perfect screening test is unanswered.
A big problem: club sport players can escape without any screening
At the very least most kids who are playing high school sports in the United States will be required to go through some form of preseason physical exam and screening. One of the concerns I have as a team physician are all of those kids playing club sports where they may not have the safety net of the preseason physical exam. It’s certainly true that most national governing bodies for club sports have a recommendation that the young athletes undergo preseason physical examination but there are very few of these national governing bodies that have a requirement that the athletes do so.If it’s not a requirement to play, most parents choose to skip the preseason physical exam. If you don’t believe me on this point you may want to confidentially poll a number of the parents in your club or league.
So while there is debate about the perfect screening method for sudden cardiac death, one thing is certain: doing something is far better than doing nothing. If you’re the parent of a high school athlete make sure that your son or daughter has a properly performed preseason physical exam. If you’re the parent of a club athlete where the exam is not required I would still strongly recommend that your son or daughter undergo a proper preseason sports physical examination. I don’t know how many kids we’re missing but the number has to be big. Don’t let the club sport athlete fall through the cracks without at least being screened. The results could be tragic.