Submitted by SCAFoundation on Mon, 09/07/2009 - 12:00am

Doctors say that all young athletes should undergo a heart check before taking part in competitive sport, to avoid the tragedy of sudden death from undiagnosed heart conditions. New research shows that doctors would need to screen 143 people to find one athlete who should not take part in sport.

The sudden death of a young person playing sport is devastating for all involved. Fortunately, it is rare: one estimate says that it happens to 1 in 28,000 young people taking part in sport. But doctors want to be able to spot young athletes at risk, in time to treat them and avoid it happening at all.

Most sudden deaths of seemingly healthy athletes during sport happen because of an undiagnosed heart problem. Doctors are divided about how to screen young athletes in order to pick up undiagnosed heart problems.

Some believe that a questionnaire about the athletes’ personal and family medical history, plus a basic medical examination, is sufficient. Others think that all competitive athletes should have an electrocardiogram (ECG) to test electrical activity in the heart. However, an ECG doesn't give a straightforward answer about cardiac health. An ECG may pick up abnormalities that are actually harmless, and therefore cause unnecessary worry. Athletes with harmless abnormalities might be told not to take part in sport, ruining their sporting careers.

Two new studies published this week suggest that the use of ECGs during a screening program can work well, provided the people reading the ECGs are trained in interpreting these results for athletes. The hearts of athletes sometimes show different results to non-athletes, because they have adapted to extra demands of sport. But the results can look abnormal to doctors who aren’t used to treating athletes.

The first study looked at what happened to 428 young university athletes in the Netherlands who were screened according to a European protocol using medical history, physical examinations, and ECGs. It showed that 87 percent of athletes screened had no problems, and they were cleared to play immediately.

The others had further tests including an echocardiogram (which uses ultrasound to build a picture of the heart), exercise stress testing where the heart is monitored during exercise, or a 24-hour ECG test. Most of these athletes were then cleared of any problems.

Overall, 10 of the athletes screened (2 percent of the total) were found to have some type of cardiovascular disease. Five of them needed no treatment, or only minor treatment for high blood pressure. The other five had some type of heart abnormality that needed investigation or treatment, and three of them were told not to take part in sport until their condition had been properly investigated and treated.

The researchers calculated that you would need to screen 143 people using their protocol in order to find one person who needed to be temporarily banned from sport because of the danger of sudden cardiac death.

Another study reviewed the evidence about ECG screening of athletes and said that, where ECGs were reviewed by experienced cardiologists, the ‘false positive’ rate was only 2 percent. That means that 2 in every 100 people screened by ECG would be told unnecessarily that they had an abnormal result and need further testing. They say this should be acceptable.

The first study was done at University Medical Centre, Gronigen, the Netherlands. The review was done by doctors at King's College Hospital, London. Both were published in the British Journal of Sports Medicine.

For almost everyone, the benefits of taking part in sport outweigh the risk of very rare problems such as sudden cardiac death. But some people have undiagnosed heart problems that can be fatal if they are untreated.

One of the UK researchers, Dr Sanjay Sharma, believes anyone aged 13 to 35 who regularly takes part in moderate to intense physical activity should be able to be screened.

 

References:

Bessem B, Groot FP, and Nieuwland W. The Lausanne recommendations: a Dutch experience. British Journal of Sports Medicine. 2009; 43: 708-715.

Papadakis M, Sharma S. Electrocardiographic screening in athletes: the time is now for universal screening. British Journal of Sports Medicine. 2009; 43: 663-668.

 

SOURCE-Adapted from article published by BMJ Publishing Group Limited ("BMJ Group") 2009