During last Friday’s high school football match up between Warren County and Smith County, there were a couple plays that could have given any body a heart attack. One heart breaking play was an attempted interception by Tyler Worthingham that bobbled into the hands of a Smith County offensive receiver for a touchdown.
Tim McIntosh (WCHS trainer), the Rotary Club, Warren County EMS, River Park Hospital, and the St. Thomas Heart Group have teamed up to provide cardiac screening for all WCHS athletes in an attempt to avoid a tragic heartbreaking loss of a young athlete to sudden cardiac death caused by hyptrophic cardiomyopathy.
Cardiac screens are expensive and this financial burden is often a reason that cardiac screen is quickly removed from budgets. Due to the volunteer efforts of individuals within the organizations above and donations of supplies, cardiac screening for all WCHS athletes is being provided at no cost to WCHS or the athlete.
There is another controversial debate with cardiac screening: Does the EKG provide quality information about an athlete’s heart?
Electrocardiograms (EKGs) are not sensitive tests. Sensitivity is a test’s ability to confidently rule out a condition if the result is a negative test. An example of poor sensitivity is if the grass is wet in the morning, it does not mean that it rained during the night.
In 1987, Maron etal. stated in the Journal of American College of Cardiology, “This failure to identify [hypertrophic cardiomyopathy] could have been due to a lack of sensitivity of the screening tests or to the low frequency with which these diseases occur in youthful healthy athletes. A systematic pre-participation screening program does not appear to be an efficient means of detecting clinically important cardiovascular disease in young athletes.”
The results of this study mean that if a WCHS athlete receives a negative result from the EKG test, the athlete may still have hypertrophic cardiomyopathy. The prevalence of hypertrophic myopathy is 1/600 and the risk of death is from this condition in high school age athletes is 1:100,000. Even if an athlete receives a negative EKG test, coaches, parents, and athletes should never ignore cardiac symptoms such as shortness of breath, chest pain, or light-headness. Furthermore, budget cuts should never consider eliminating the need for a Certified Athletic Trainer like Tim McIntosh, ATC on-site during athletic programs.
If the EKG testing has such limitations, why is UTK and WCHS making this test mandatory for all athletes?
EKGs are highly specific. A specific study means that if an athlete has a positive test for hypertophic cardiomyopathy, the physician will be certain that the athlete has this condition. In cases of acute cardiac failure, EMS and sports medicine staff have approximately 6 minutes to save a life, but with the EKG, prevention can occur and less invasive life-saving measures can be taken.
In a 1997 article in the journal, Medicine and Science in Sports and Exercise, Fuller etal stated, “Cardiac history led to detection of outcome measures in 0 athletes, auscultation/inspection in 1/6,000 athletes, blood pressure measurement in 1/1,000 athletes, and the EKG in 1/350 athletes.” Translation: EKG is much better than the traditional pre-prarticipation physical for finding this deathly condition.
In a 2011 article in the British Journal of Sports Medicine, Hevia etal conclude their study stating, “Given the ability of 12-lead EKG to detect individuals with structural heart disease, we suggest its inclusion as a part of pre-participation screening programs.” The American Heart Association also supports the use of EKG to detect hypertrophic cardiomyopathy.
Additionally, there is evidence in recent medical literature that supports mandatory cardiac testing. Since Italy implemented mandatory EKG testing for all athletes in 1982, Italy has demonstrated an 89% reduction in sudden cardiac death.
EKG testing for athletes does not abolish the risk and warning sign always need to be examined by a medical professional. However, when an athlete is identified with EKG to have the life threatening condition of hypertrophic cardiomyopathy, there will be no doubt or speculation about the finding and the athlete will be safer for it.
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