Monday, the national Cardiac Arrhythmia Syndromes (CAS) Foundation, together with All Children’s Specialty Physicians and Hillsborough County Public Schools, held a press conference to announce that a new, free teen heart screening program for high school students called the SafeBeat Initiative will begin in Hillsborough County starting next week.
According to Tampabay.com reporter Letitia Stein, this is the largest such voluntary screening effort of seemingly healthy high school students.
Typically, many college health services such as the University of Florida target cardiac screening for student athletes, but not the rest of the student population.
The SafeBeat Initiative is a national program developed by the CAS Foundation because, according to CAS, each year more than 7,000 children and adolescents in the United States die from sudden cardiac arrest. While other organizations such as the American Heart Association report far fewer numbers, there is no doubt that it is a serious problem.
According to the Cleveland Clinic, sudden cardiac arrest is responsible for half of all heart disease deaths. Sudden death occurs most frequently in adults in their mid-30s to mid-40s, and affects men twice as often as it does women. Sudden cardiac death is rare in children, affecting only 1 to 2 per 100,000 children each year.
In the case of teens, eighty percent appeared perfectly healthy and had no symptoms prior to their deaths. Sudden deaths in younger athletes are more often associated with congenital structural abnormalities of the heart and blood vessels, while sudden cardiac deaths in athletes over age 35 tend to be associated with acquired atherosclerotic coronary artery disease
Sudden cardiac arrest is not a heart attack, which occurs when a blockage to one or more of the coronary arteries prevents oxygen-rich blood from getting to the heart muscle causing damage.
Sudden cardiac arrest occurs because the electrical system to the heart doesn’t function properly and suddenly becomes irregular. This is called an arrhythmia. As a result, the heart beats too fast and the heart chamber called the ventricles may flutter or quiver erratically (ventricular fibrillation) so that blood cannot be delivered to the body. The initial concern in the first few minutes is loss of blood to the brain resulting in loss of consciousness. Unless emergency treatment including defibrillation with a defibrillator is administered, death occurs.
As early as 18 years ago, the then president of the American College of Sports Medicine recognized that while changing rules such as having water available at football practice and modifying helmets and other equipment had resulted in decreased sports-related deaths, there was a significant rise in sudden death in high school and college athletes who had underlying congenital cardiovascular disease.
Since then recommendations for screening strategies have been hampered by inadequate data as to the prevalence of inherited cardiac syndromes such as the Long QT syndrome that might lead to sudden cardiac death in young people. A March report in the Annals of Internal Medicine concluded that screening EKGs alone without a cardiovascular-focused history and physician exam may not be cost-effective.
Today the American Heart Association recommends that all high school and college athletes have a screening medical history and physical examination prior to engaging in school athletics. repeated every two years.
The medical history should specifically bring to light any of the following symptoms:
•Chest pain or discomfort during exercise
•Loss of consciousness
•Shortness of breath on exertion
•A history of a heart murmur or hypertension
Family history should include any member who died before age 50, death or disability from heart disease in close relatives, and whether there is a family history of genetic-related heart problems such as hypertrophic cardiomyopathy, long-QT syndrome, serious cardiac arrhythmias, or Marfan syndrome.
History of drug use is also important. A 2009 study suggests that children and teens who take stimulants like Ritalin for Attention Deficit Hyperactivity Syndrome (ADHD) for have an increased risk for sudden cardiac death, but so far the FDA says the study has major limitations and should not change the way the drugs are used.
An examination by a physician should include listening to the heart while the individual is standing and lying down to identify heart murmurs and other problems.
The SafeBeat initiative includes only a free electrocardiograms (EKGs) which can cost as much as $150 in a doctor’s office. While an EKG identifies many abnormalities, it may miss some inherited abnormal rhythms. That’s why, without a complete physical exam conducted by a qualified health professional including a complete family history, parents should not feel that they have ruled out every possible cause for sudden cardiac death in their child.
Starting next week, CAS working the All Children’s Hospital in St. Petersburg will offer EKGs to students at 7 Hillsborough high schools. If the initial screening goes well, organizers plan to expand along Florida's west coast. Results will be sent electronically to cardiologists at All Children's who will notify parents and recommend follow-up based on the findings. For those who cannot afford a doctor’s visit, All Children's, has promised to provide free follow-up care.
For more information: Contact SafeBeat