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October 2008

Heart Disease Screening for Young Athletes

Anthony Luke, M.D., M.P.H.
Primary Care Sports Medicine Specialist
UCSF Sports Medicine Center

High profile athletes, such as Reggie Lewis and Hank Gathers, have died from sudden cardiac death, which has raised the awareness of the condition in all athletes. The role of electrocardiogram (ECG) in pre-participation physical exams to identify athletes at risk of cardiac sudden death is a recent controversy in sports medicine. An ECG can identify abnormalities caused by hypertrophic cardiomyopathy — the leading cause of sudden cardiac death in the United States — in an estimated 90 percent of cases.1

While some athletes are screened for heart conditions due to warning symptoms such as chest pain, heart palpitations and lightheadedness with exercise, many athletes do not experience any symptoms but are still at risk of sudden cardiac death. The risk in high school and college athletes of sudden death from all causes is 1 in 200,000.2

A recent study conducted in Italy by Corrado et al. reports their experience with ECG screening over 25 years. As mandatory ECG screening among athletes was introduced, a decreased mortality from sudden death from cardiomyopathies (1.50 to 0.15 in 100,000 people) was noted.3 Another Italian study identified 81 out of 12,550 athletes who had inverted T waves (2mm or more in at least three leads) identified on an ECG, but who were otherwise asymptomatic. These athletes were followed for an average of nine years; five out of 81 developed cardiomyopathy and one died from cardiac sudden death.4

ECG Screening

The International Olympic Committee (IOC) recommends a resting ECG for athletes as part of their pre-participation physical exam (PPE), which several European countries perform.

In North America, the American Heart Association (AHA) recommends only a PPE and not a routine ECG unless there is clinical concern for the athlete to have one.5 The AHA recommends conducting a detailed history for cardiac symptoms and risk factors, followed by a careful cardiac examination, including auscultation of the heart for murmurs in prone and standing positions, palpating femoral pulses bilateral for aortic coarctation, checking for signs of Marfan's syndrome and blood pressure measurement.

  1. Maron B.J., McKenna W.J., Danielson G.K., et al. American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol. Nov. 5, 2003; 42(9):1687-1713.
  2. Maron BJ, Gohman TE, Aeppli D. Prevalence of sudden cardiac death during competitive sports activities in Minnesota high school athletes. J Am Coll Cardiol. Dec, 1998; 32(7):1881-1884.
  3. Corrado D., Basso C., Pavei A., Michieli P., Schiavon M., Thiene G. Trends in sudden cardiovascular death in young competitive athletes after implementation of a preparticipation screening program. Jama. Oct. 4, 2006;296(13):1593-1601.
  4. Pelliccia A., Di Paolo F.M., Quattrini F.M., et al. Outcomes in athletes with marked ECG repolarization abnormalities. N Engl J Med. Jan. 10, 2008; 358(2):152-161.
  5. Maron B.J., Thompson P.D., Ackerman M.J., et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation. March 27, 2007; 115(12):1643-1455.
For more information, contact the Physician Referral Service at UCSF Medical Center:
Phone (888) 689-UCSF or (888) 689-8273
Email referral.center@ucsfmedctr.org

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