ANN ARBOR, Mich. – As the fall sports season starts for students, millions will hit the court, the rink and the field. Every year, it seems we hear a tragic story of a young person suffering a cardiac event while participating in school sports.
But who is at risk for a cardiac event and what screening process is recommended for student athletes?
“Every year, we hear about deaths among young athletes on the sports field or on the court,” says Mark Russell, M.D., pediatric cardiologist at the University of Michigan’s C.S. Mott Children’s Hospital. “It is a very devastating but very uncommon event. It will occur in about 100 athletes a year throughout the United States, and that’s an incidence of about 1 in about 40,000.
“There are many causes of sudden cardiac death among seemingly healthy young athletes,” Russell says. “There’s no one single cause and there’s no one single way of identifying those patients who are at risk. That’s what makes it such a great challenge.”
The American Heart Association has not recommended electrocardiograms in all student athletes due to a lack of evidence that they are able to reduce the number of sudden deaths.
Rather, the AHA recommends that students undergo a pre-participation screening that includes a detailed family history, personal history and a physical exam that includes blood pressure measurement and listening to the heart.
Sudden cardiac death in young athletes is often caused by an underlying heart disease such as hypertrophic cardiomyopathy, which is inherited from one generation to the next.
“Simply improving pre-participation screening and conducting electrocardiograms on properly selected children may help reduce cardiac deaths,” says Sharlene M. Day, M.D., director of the hypertrophic cardiomyopathy clinic at the U-M Cardiovascular Center.
“It is also very important for athletes, their families, and their coaches to recognize potential warning signs, like a seizure, passing out, or shortness of breath,” she says.
In September, the University of Michigan Health System will host an educational forum for educators and child health experts that teaches how to respond to school emergencies on and off the field.
U-M experts support having automated external defibrillators available in schools and training coaches and other school personnel on use and maintenance of the devices. Yearly training in basic life support or CPR for coaches and trainers can help them to respond as quickly as possible in an emergency.
Emergency response training programs will have the added benefit of not only improving a school’s ability to respond to an emergency that occurs on the sports field but to any emergencies that occur on school property. It will also prepare individuals who will take their emergency response skills to their home and to their community.
Finding a needle in a haystack
Making sure that all Michigan schools, public and private, use new athlete screening forms and that the athletes screenings are performed by physicians familiar with AHA guidelines are an important step in preventing sudden cardiac deaths.
“Sports screening should be a tiered process and advanced testing should be performed if there are abnormalities,” Russell says. “Sports screening physicals are not meant to take the place of a visit to the primary care physician. Those programs are meant to complement what happens at the doctor’s office.”
As many as 10 million to 12 million young athletes in the United States participate in competitive athletics. Identifying which of those athletes is at significant risk of sudden death is a bit like finding a needle in a haystack, doctors say.
“Because of the benefits to cardiovascular health, we would like to encourage as many people as possible to be able to participate in organized sports,” Russell says. “At the same time we want to counsel or identify those patients who are at risk for sudden cardiac arrest. That’s a very delicate balance.”
For a copy of the updated Michigan High School Athletic Association athlete physical form
University of Michigan Cardiovascular Center
Michigan Department of Community Health Report: Sudden Cardiac Death of the Young
Written by Shantell M. Kirkendoll