Re: Should athletes be screened for heart problems?

[Guest guest]

Hypertrophic cardiomyopathy is the leading cause of sudden death in young

athletes. The cost of performing echocardiograms on every athlete would be

prohibitive. Finding someone with HCM would be like finding a needle in a

haystack. Family history is an acceptable and cheaper predictor.

Tom Fahey

Dept. Kinesiology

California State University, Chico

Chico, CA 95929

discusdoc@...

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Re: Should athletes be screened for heart problems? - New Scientist From:

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Re: Should athletes be screened for heart problems? - New Scientist

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awwshucks32 <awwshucks32>

Mon Mar 26, 2012 7:55 am (PDT)

I am not a doctor, however I think that athletes should be screened for heart

problems. Athletes really exert themselves and it can really affect the heart.

Screenings can prevent a lot of problems, both in the short and long term, and I

think they should be required.

Philip Hoffman

Norton, Ohio

>

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[Guest guest]

At the university I work at we are always looking at our physicals, health

history forms, and any new thoughts on what we should be doing in a

pre-participation physicals. We had an episode with an athlete a few years back

that luckily with an AED we were able save. Nothing would have shown on any

test we would have done, the athlete only found out the issue after a few years

of testing.

We have settled on the following through work with our team physician.

A thorough heart screen questionnaire and health history form is vital. A

physical correctly done with a detailed health history form is a must. Seeing

too many crappy clinic physicals that give us nothing. Kids are paying for the

service and are guaranteed no one fails. - another discussion

EKGs produce too many false negatives for what they can tell us

Echos are nice but cost for us is prohibitive.

Terry ATC/L; CSCS ; NASM-PES

Head Athletic Trainer

Aurora University

Aurora, IL USA

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[Guest guest]

As a result of this topic, I took a look at how much it would cost to

get cardiac screening done, here in the UK, There is a charity called

CRY, dedicated to precisely this activity, they have a mobile

screening service, which trundles around the country.

From their e mail response, they require several rooms to operate from

and charge £35.00 per head. Unfortunately, they require £ 3500.00 for

the day and, the service is booked up until 2013. I don't know 100

junior athletes and, although we have a good club house ( we are a

canoe slalom club) it would be very difficult, if not impossible to

fulfill the criteria. The cost and length of time to get an

appointment might suggest there is a demand for this type of activity

but, £ 3500.00 is an awful lot of money.

Kendall Chew

Cheshire, UK.

[Guest guest]

I think that the cost of the pre-participation screening is being overblown.

 The following is an article concerning the pre-participation screening in

Italy. They screen about 3 million citizens annually.

  http://eurheartj.oxfordjournals.org/content/27/18/2196.full.pdf

******************************************

 http://eurheartj.oxfordjournals.org/content/27/18/2196.full.pdf

All citizens participat-

ing in organized and competitive sports are required to undergo pre-

ventive general medical and cardiovascular evaluation, which

routinely includes 12-lead ECG, in addition to personal and familyhistory and

physical examination (with measurement of blood

pressure). 

Several investigations have clarified the spectrum of patho-

logical conditions responsible for athletic field deaths, with

HCM the most common in the USA and responsible for about

one-third of all such events occurring during sport

participation.2– 5

In contrast, the number of athletic field deaths due to

HCM in Italy is negligible,6,7 despite a prevalence of the

disease in the general population apparently similar to

that in other countries 

*************************************** 

http://www.c-r-y.org.uk/why_should_we_introduce_an_ecg_p.htm

Contrary to what people are led to believe Sudden Death Syndrome is not very

rare. Research has shown that 1 in 500 people have Hypertrophic Cardiomyopathy

(HCM) alone. This makes this one condition 5 times more common than Cystic

Fibrosis.

At least 12 young people die suddenly each week in the UK of cardiac

abnormalities - sudden death syndrome or sudden cardiac deathMany of these

deaths are preventable. Many have had symptoms that have not been recognised.

Some will have gone to a doctor or hospital and been sent home without even

having been given an ECG test.Identifying those at risk saves lives.

An essential requirement of the ECG testing programme will be to fill in a

questionnaire recording both personal and family history. A family history is

considered positive if one or more close relatives has had a premature heart

attack. Personal history would be considered positive if the subject has chest

pain or discomfort, fainting or near-fainting, or irregular heartbeat or

palpitations on exertion, or if the subject had shortness of breath or fatigue

on exertion that was out of proportion to the degree of physical effort.

*****************************************

In Connecticut every high school athlete is required to have a pre season

medical clearance every year.  The only addition need for the screening for HCM

would be a family history question air and a 12 lead ECG.  HCM is an inherited

condition.  Family history and ECG would eliminate the vast majority of

athletes and effort s would then be confined to those would be athletes who fail

the screening.   How much does it cost to have someone fill out a screening

questionaire? - ECG would be done based on the results of the questionnaire.

 Cost of ECG about $60.  Further testing would be done if index of suspicion

is raised by the ECG.  How much is a young persons life worth?

Ralph Giarnella MD

Southington Ct. USA 

________________________________

From: Kendall Chew <chew.k3@...>

Supertraining

Sent: Wednesday, March 28, 2012 4:38 AM

Subject: Re: Should athletes be screened for heart problems?

 

As a result of this topic, I took a look at how much it would cost to

get cardiac screening done, here in the UK, There is a charity called

CRY, dedicated to precisely this activity, they have a mobile

screening service, which trundles around the country.

From their e mail response, they require several rooms to operate from

and charge £35.00 per head. Unfortunately, they require £ 3500.00 for

the day and, the service is booked up until 2013. I don't know 100

junior athletes and, although we have a good club house ( we are a

canoe slalom club) it would be very difficult, if not impossible to

fulfill the criteria. The cost and length of time to get an

appointment might suggest there is a demand for this type of activity

but, £ 3500.00 is an awful lot of money.

Kendall Chew

Cheshire, UK.

[Guest guest]

When they get the EKG and it says " abnormal " or " possible " something then they

will see their primary care who will then refer them to cardiology who will

inevitably do an echocardiogram and possibly a cardiopulmonary exercise test to

see if the rhythm abnormality changes or disappears in exercise.

The primary care will send to cardiology to cover his butt. The cardiologist

will do enough tests to cover his butt. And finally the parents who hear of a

" murmur " will push for enough tests for a guarantee of their child's safety

while pursuing competitive sports.

They will catch some undiagnosed heart issues, but the opportunity cost of this

is the tricky thing.

Would having a trainer or an extra trainer, or better safety equipment and

facilities be more beneficial to the health of the team or EKG screening and the

inevitable follow-ups? Not an easy answer.

FYI-I am an exercise physiologist working for a pediatric cardiology group

running their cardiopulmonary lab.

Taskey

Kent, WA