Cardiac Screening

Every week I sit down and write about getting off the couch and exercising. However, as we begin the football season, I am reminded of the risk of vigorous exercise, particularly in a sport such as football that adds heavy, often suffocating pads to a hot environment mixed with a high risk for trauma.

General awareness regarding sudden death in young athletes has increased over the past few years. Medscape Medical estimates the risk for sudden cardiac death to be 1:100,000 for high schoolers and 1:65,000 for college athletes. While that does not seem like a lot, it is actually about 90 athletes per year in the U.S.

While the risk is very low, the loss of one of our young athletes would be tragic.

Tim McIntosh, ATC, LAT, Warren County High School's Head Athletic Trainer, has an Emergency Action Plan that includes annual training of emergency situations. In addition to being certified by the National Athletic Trainers Association and Licensed in the State of Tennessee, he is certified in Cardiopulmonary Resuscitation (CPR) and keeps an Automated External Defibrillator (AED) at hand. He stresses that the AED is a life-saving device, but its success is dependent on administering the AED within 5 minutes of the cardiac event.

Dr. Robert Benson, MD, Warren County's only resident cardiologist, reports that the majority of these cases are completely sudden with no history of medical problems until the cardiac arrest occurs. While routine physicals are crucial, the only way to detect the cardiac conditions that place a young athlete at risk is with an evaluation with a cardiologist. Cardiologists use an Electrocardiogram (EKG), as a non-invasive, monitoring system to read the signals given off by the heart for a few minutes. This screening tool allows cardiologist to determine if any abnormal signs are present in the heart. If any concerning signs are noticed, cardiologists will often perform additional tests like an echocardiogram, heart catheter, or cardiac MRI to make an accurate diagnosis. A trained cardiologist, such as Dr. Benson, is able to detect conditions such as hypertrophic cardiomyopathy, the common cause of sudden cardiac death in high school athletes, that cannot be detected in a routine physical examination. Once tested, the results should last throughout the young athlete's sports career.

An article in The Journal of the American Medical Association in 2006, confirmed the value of EKG screening, but this is still not yet a common practice nationally. The Sun Sentinel reported in March that mandatory EKG testing reduced sudden cardiac death by 89% in Italy in athletes between 14 and 35 years old. Since these results were published the European Society of Cardiology and the International Olympic Committee now recommend EKG screening of all competitive athletes. The University of Tennessee-Knoxville's Department of Sports Medicine is on the cutting edge and started utilizing EKG screens with all their student athletes three years ago. The American Heart Association has not taken the same stance yet, continuing only to recommend a medical history and physical examination at this time. Therefore, EKG screening is still on a voluntary basis in Warren County.

The major limitation is the cost of the EKG and the Cardiologist visit, however, I was pleased to find that the majority of insurances will approve a one-time wellness visit to a cardiologist. Being a cutting edge cardiologist, Dr. Benson is offering to accept the highest risk athletes, the Warren County Football players, for a cardiac wellness visit this Fall. Warren County football player parents can schedule a cardiac wellness appointment for their child with Dr. Benson at 931-815-4770.

With Tim McIntosh's and Dr. Benson's help, it is my hope that our young athletes are safer than the national statistics. Go Pioneers!

Zach Sutton, DPT, MS, OCS