Sudden deaths among teen athletes spur screening debate
Within the past month four teen athletes have suffered sudden cardiac death. In Michigan, Wes Leonard, a high school basketball player, died due to cardiac arrest due to an enlarged heart. Shortly after, Matthew Hammerdorfer, a 17-year-old Colorado rugby player died during a match due to cardiac arrest and Jarvis Brinkley, a North Carolina 16-year-old, died of heart failure after playing basketball. As if three teen athletes in one month were not enough, Sarah Landauer, a 17-year-old soccer and track star from Florida also collapsed and died, although the precise cause of her death is still undetermined.
About 50-100 sudden deaths occur among athletes in middle school, high school and college every single year. However, these recent deaths have rekindled an old debate as to whether or not young athletes should be required to obtain heart screenings.
One issue with heart screenings, according to area cardiologist Dr. Kenneth Shafer M.D., is the fact that little research exists to show that screenings actually make a difference.
“It hasn’t been shown that doing a lot of screening tests on large populations of athletes decreases the risk of sudden death, although there is obviously a lot of interest in finding a sure-fire way to identify those at risk,” Shafer explained. “It is very expensive to find a single person at true risk and many people who are denied participation in athletics because of test results are probably not at risk.”
Shafer makes a good point, and there are studies that concur with his opinion. According to a Reuters news report released last week, a new study found mandatory electrocardiogram (EKG) screening programs in Italy and Israel had no impact at all on the number of athlete deaths.
If tests are performed on young athletes to determine their risk, Shafer said those investigations should include two heart tests to decrease the chance that life-threatening heart defects may be missed.
“The chance of finding an abnormality is rare, but if screenings are performed and an abnormality is missed, then the consequences can be catastrophic,” he said.
The two heart tests that are typically used in these screenings are an echocardiogram, or ECHO, which measures heart size and pumping function and checks for faulty heart valves, and an electrocardiogram, or EKG, which assesses the electrical rhythms of the heart.
Shafer said that research indicates more than 3,000 people aged 15 to 34 succumb to sudden cardiac death as a result of heart rhythm disturbances every year in the United States. Would screenings prevent any of these 3,000 deaths? That’s not an easy question to answer. However, using only an EKG as a screening device would not be as sensitive as using both an ECHO and an EKG.
A recent study presented at the annual meeting of the American Heart Association involved 134 Maryland high school athletes. The researchers conducting the study were looking for life-threatening cardiac abnormalities such as hypertrophic cardiomyopathy, a condition in which the heart muscle thickens abnormally and whose patients often have no symptoms.
Although none of the student athletes were found to have life-threatening heart defects, 36 had abnormal findings on the ECHO or EKG. Twenty-two abnormalities were detected by the EKG alone and nine by the ECHO alone, and five were picked up on both tests.
“By only doing one of the two tests, a significant number of abnormalities in that study would have been missed,” Shafer explained. “If you’re going to do screenings, ideally on a selected group of individuals rather than on the entire population of athletes, those screenings need to be more comprehensive. While an EKG does give you a lot of information, it doesn’t tell you the whole story.”
In some countries, federal law mandates screening of young athletes. It is doubtful that will ever be the law here in the United States. There is also the possibility that too much testing can have negative consequences.
Shafer cited information contained in the Maryland high school study.
“In that particular study, one in four athletes had abnormal test results, but none had significant problems,” he said. “There is a risk the tests could identify people who don’t have life-threatening problems. This could cause undue stress and worry or cause the athlete to avoid participation in sports unnecessarily.
“Every athlete should undergo a medical history and physical exam prior to beginning a sport,” Shafer said. “Abnormalities on the exam, such as an unexplained murmur or irregular pulse, or in the history, such as a family history of sudden death or personal history of exertionally related symptoms, should prompt further investigation of tests such as ECHO and EKG. Additionally, any symptoms, such as shortness of breath, fainting or chest pains that occur during sports-related activities, should be taken seriously and brought to the attention of the coaches and personal physician.”
About 50-100 sudden deaths occur among athletes in middle school, high school and college every single year. However, these recent deaths have rekindled an old debate as to whether or not young athletes should be required to obtain heart screenings.
One issue with heart screenings, according to area cardiologist Dr. Kenneth Shafer M.D., is the fact that little research exists to show that screenings actually make a difference.
“It hasn’t been shown that doing a lot of screening tests on large populations of athletes decreases the risk of sudden death, although there is obviously a lot of interest in finding a sure-fire way to identify those at risk,” Shafer explained. “It is very expensive to find a single person at true risk and many people who are denied participation in athletics because of test results are probably not at risk.”
Shafer makes a good point, and there are studies that concur with his opinion. According to a Reuters news report released last week, a new study found mandatory electrocardiogram (EKG) screening programs in Italy and Israel had no impact at all on the number of athlete deaths.
If tests are performed on young athletes to determine their risk, Shafer said those investigations should include two heart tests to decrease the chance that life-threatening heart defects may be missed.
“The chance of finding an abnormality is rare, but if screenings are performed and an abnormality is missed, then the consequences can be catastrophic,” he said.
The two heart tests that are typically used in these screenings are an echocardiogram, or ECHO, which measures heart size and pumping function and checks for faulty heart valves, and an electrocardiogram, or EKG, which assesses the electrical rhythms of the heart.
Shafer said that research indicates more than 3,000 people aged 15 to 34 succumb to sudden cardiac death as a result of heart rhythm disturbances every year in the United States. Would screenings prevent any of these 3,000 deaths? That’s not an easy question to answer. However, using only an EKG as a screening device would not be as sensitive as using both an ECHO and an EKG.
A recent study presented at the annual meeting of the American Heart Association involved 134 Maryland high school athletes. The researchers conducting the study were looking for life-threatening cardiac abnormalities such as hypertrophic cardiomyopathy, a condition in which the heart muscle thickens abnormally and whose patients often have no symptoms.
Although none of the student athletes were found to have life-threatening heart defects, 36 had abnormal findings on the ECHO or EKG. Twenty-two abnormalities were detected by the EKG alone and nine by the ECHO alone, and five were picked up on both tests.
“By only doing one of the two tests, a significant number of abnormalities in that study would have been missed,” Shafer explained. “If you’re going to do screenings, ideally on a selected group of individuals rather than on the entire population of athletes, those screenings need to be more comprehensive. While an EKG does give you a lot of information, it doesn’t tell you the whole story.”
In some countries, federal law mandates screening of young athletes. It is doubtful that will ever be the law here in the United States. There is also the possibility that too much testing can have negative consequences.
Shafer cited information contained in the Maryland high school study.
“In that particular study, one in four athletes had abnormal test results, but none had significant problems,” he said. “There is a risk the tests could identify people who don’t have life-threatening problems. This could cause undue stress and worry or cause the athlete to avoid participation in sports unnecessarily.
“Every athlete should undergo a medical history and physical exam prior to beginning a sport,” Shafer said. “Abnormalities on the exam, such as an unexplained murmur or irregular pulse, or in the history, such as a family history of sudden death or personal history of exertionally related symptoms, should prompt further investigation of tests such as ECHO and EKG. Additionally, any symptoms, such as shortness of breath, fainting or chest pains that occur during sports-related activities, should be taken seriously and brought to the attention of the coaches and personal physician.”
Published: April 3, 2011
