Cardiac Screening for Student Athletes
Cardiac Screening for Student Athletes
We are offering cardiac screening for all high school and collegiate students in the Tampa Bay Area. Most sports physicals in the United States only include a verbal history and limited physical exam. We believe a more thorough exam is needed to prevent cases of sudden cardiac death in our youth. We are the only practice in town offering history and physical, electrocardiogram (EKG), and echocardiogram (ultrasound of the heart) as the sports physical standard. With these tests we can rule out the most common causes of sudden cardiac death in young athletes. This offers parents and students more peace of mind when competing and exercising at the highest levels. Please read below for further information:
Sudden cardiac arrest (SCA) is when the heart suddenly stops beating. If not treated immediately, SCA will lead to sudden cardiac death (SCD). But even with treatment, most people with SCA do not survive.
SCA is most likely to happen in people with underlying structural or electrical heart disease. These can be inherited or acquired. Other causes include infection, certain medications, drugs, and stimulants. For a full detailed list, scroll to bottom of page to view common causes of SCA.
Unfortunately, most people who experience SCA do not have warning signs prior. That is why screening is so important. Up to half of people with SCA will experience symptoms just prior to SCA or in the days leading up to the event. These symptoms include irregular heartbeat, dizziness, chest pain or shortness of breath. When SCA happens, the person will lose consciousness, have no pulse, and will stop breathing.
Circulation, an American Heart Association journal, estimated that there are approximately 100 to 150 sudden cardiac deaths during competitive sports each year. This estimate was reported in 2012.
UpToDate, an evidence-based clinical resource, lists the incidence of SDC between 1:50,000 and 1:100,000 per year in young athletes.
How much does this screening cost?
The price is $300 which includes:
- Meeting with the physician assistant to take a thorough medical history
- Physical exam including vital signs
- Electrocardiogram (EKG)
- Echocardiogram (ultrasound of the heart)
- Results mailed to you
Unfortunately, insurance in the US does not cover screening visits or tests. Soon, we will be offering financial assistance to get all students screened, regardless of their financial status.
Screening is open to all high school and collegiate student athletes.
Short answer: every 2 years
Long answer: In the US, it is recommended to screen high school student athletes every 2 years and collegiate athletes every 3-4 years. In Europe, it is recommended to screen all student athletes every 2 years. Italy has released data of decreased incidence of SCD when they mandated the screening program from 3.6/100,000 person/year down to 0.4/100,000 person/year. European screening guidelines include history and physical exam plus electrocardiogram (EKG), but they do not require an echocardiogram (ultrasound of the heart).
You will be asked to download our new patient paperwork. Prior to your appointment, please fill this out with your parent or guardian; it is important we get an accurate family history as some abnormalities can be genetic and passed down through generations. If you are under 18 years old, we ask that you be accompanied by your parent or legal guarding on the day of your visit.
On the day of your visit, your vital signs (blood pressure, heart rate, height, weight, oxygen saturation) and electrocardiogram (EKG) will be taken by our medical assistant. You will sit and talk with our physician assistant who will take a thorough medical history and perform a physical exam. Next, you will see our cardiac sonographer who will take ultrasound pictures of your heart as you lay down. The appointment will not include any invasive procedure. There are no needles involved.
On the day of testing, you will have a preliminary result: normal or abnormal. If abnormal, we will see you back right away and further testing will be recommended. If normal, after 2-3 weeks we will mail you a copy of your EKG and echocardiogram along with a more detailed report of your results.
Specific recommendations will be given depending on the diagnosis. In general, if your results are abnormal it is recommended to avoid:
- “Burst” exertion, involving rapid acceleration and deceleration, as is common in sprints, basketball, tennis, and soccer. Activities with stable energy expenditure, such as jogging, biking on level terrain, and lap swimming are preferred.
- Extreme environmental conditions (temperature, humidity, and altitude) that impact blood volume and electrolytes.
- Systematic and progressive training focused on achieving higher levels of conditioning and excellence.
Common Causes of SCA in Detail
(from parentheartwatch.org)
Structural / Functional Causes Arrhythmogenic Right Ventricular Dysplasia (ARVD)
A form of cardiomyopathy in which the heart muscle of the right ventricle is replaced by fatty-fibrous tissue. The scar tissue interrupts the normal smooth sequence of electrical activity that causes the heart muscle to contract, leading to arrhythmias. The weakened muscle will stretch, producing an enlarged right ventricle, which may not pump as effectively as a heart without ARVD. ARVD is often inherited.
Coronary Artery Abnormalities (CAA)
An abnormality or malformation of the coronary artery, a blood vessel that supplies blood to the heart muscle. This condition is present at birth but can be silent for years until very vigorous exercise is performed. During exercise, blood flow to the heart muscle can be impaired and result in ventricular fibrillation.
Dilated Cardiomyopathy (DCM)
The most common form of cardiomyopathy and occurs when heart muscle tissue is enlarged and stretched, making it difficult for the heart to function. DCM usually follows a viral infection.
Hypertrophic Cardiomyopathy (HCM)
The second most common type of cardiomyopathy and results in excessive thickening of the heart walls, usually on the left side. The thickened heart muscle can block blood flow out of the heart and can increase the risk of ventricular fibrillation. In over half of the cases, this heart disorder is hereditary. HCM is the most common cause of sudden cardiac death in athletes in the United States.
Kawasaki Disease
Characterized by inflammation of blood vessels throughout the body including the coronary arteries of the heart. It often begins with a persistent high fever greater than 102°F, often as high as 104°F, which typically lasts at least 5 days and does not usually go away with normal doses of acetaminophen (Tylenol) or ibuprofen.
Marfan Syndrome
An inherited abnormality of the connective tissue (ligaments and tendons) in the body. The wall of the aorta, the main artery of the heart, can become weak and rupture, especially during exercise. Often, affected people are tall and thin with long arms, legs, fingers, and toes.
Mitral Valve Prolapse (MVP)
A disorder that affects one of the heart’s valves — the mitral valve. The mitral valve doesn’t close properly allowing backward leaking of blood from the heart’s chamber. This may predispose some people to endocarditis, an infection of the heart valves and parts of the inside lining of the heart muscle, due to bacteria that adhere to the valve from dental work.
Myocarditis
An inflammation of the heart muscle caused by either a viral, bacterial, or fungal infection. It is often caused by the Coxsackie virus. It causes the weakening of the heart’s pumping action and decreases its ability to supply oxygen-rich blood to the body. Most people recover from viral myocarditis with no ill effects. It is better not to participate in sports when a fever, chills, and muscle aches are present, or symptoms are indicative of a bad cold.
Electrical Causes Brugada Syndrome
An abnormality of the heart cells that disrupts the electrical activity in the heart and can cause life-threatening heart rhythms.
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)
Characterized by exercise or stress-induced ventricular arrhythmias in which the heart’s lower pumping chambers go into very rapid and uncontrolled rhythms that do not pump blood effectively.
Long Q-T Syndrome (LQTS)
A disturbance of the heart’s electrical system. A genetic mutation causes a defect in the heart cells, called ion channels, which then prolongs the time the heart takes to electrically recharge after each heartbeat (known as the QT interval). LQTS is usually inherited. In other cases, LQTS can be caused by certain medicines, toxins, electrolyte disturbances, or other forms of heart disease.
Wolff-Parkinson-White Syndrome (WPW)
A condition in which the normal electrical signals in the heart travel along an extra, abnormal electrical pathway. This condition can create a “short circuit” in the electrical system and lead to abnormally fast heart rates (tachycardia). WPW is sometimes inherited.
Other Causes:
Commotio Cordis
A condition that causes cardiac arrest if a sudden blow to the chest occurs at a critical point when the heart is electrically re-charging. It can occur with an impact of very little force. It is usually caused by a baseball, lacrosse ball, or hockey puck despite the use of a chest protector. Chest protectors are designed primarily to protect a child from soft tissue damage and bone injury on impact; not as protection from the potentially fatal heart rhythm that can also occur as a result of impact. Wearing a chest protector, thus, creates a false sense of security. Commotio cordis is the second leading cause of death in young athletes while playing baseball, usually occurring between the ages of 7 and 16.
Drugs or Stimulants
Even someone with a completely normal heart can develop ventricular fibrillation and die suddenly due to drug or stimulant use, which includes performance-enhancing drugs, high-caffeine energy supplements, or diet pills.