EKG and Sudden Cardiac Death Fact Sheet We recently made the decision to offer free sports EKGs at certain Cook locations for limited times--Sudden Death Awareness month (Oct), “heart month” (February) and at times when they are frequently requested (late summer, prior to school). It is estimated that SCA (sudden cardiac arrest) claims the lives of over 1000 children and adolescents each year in the United States, accounting annually for approximately 5% of all childhood deaths in children aged 5–19 years. SPORT EKGs: The incidence of SCD is greatest in football and basketball, and has been noted to be higher in black athletes and in boys. Under AHA guidelines, the United States continues to recommend screening only by H&P without an ECG. Pro EKG screening: Conditions that can be identified using the ECG are responsible for at least two-thirds of SCA in the young, with coronary artery anomalies being the most notable exception. There is a general consensus that ECG is more sensitive in identifying those at risk for SCA than H&P alone. In one study the ECG was three times more likely to identify those at risk than the H&P alone. Hypertrophic cardiomyopathy is the most common etiology of sudden death in young athletes. Over 90% of patients with HCM will have an abnormal ECG. In the largest United States ECG screening study of 5615 high school athletes in Nevada, the sensitivity of the ECG to identify serious cardiovascular abnormalities was 70 vs. 6% for H&P. Overall, only 0.4% of athletes were disqualified from competition. Con: No testing/screening methodology will ever detect 100% of patients at risk (and) There is recognition that the ECG has a false-positive rate (1.9-16%) that leads to additional testing, possible disqualification, and the potential for anxiety or distress until the correct diagnosis is determined. The AHA panel does not recommend the routine use of tests such as an ECG or echocardiography in the context of mass, universal screening. This view is based on the substantial size of athletes to be screened, the relatively low prevalence of cardiovascular conditions responsible for sports related deaths, the limited resources presently available for allocation, and the absence of a physician examiner cadre prepared and available to perform and interpret these examinations. No true sensitivity or specificity data exist for prediction of risk of SCA by pre-participation evaluations. Among the many warning signs and symptoms, the following appear to represent the ominous positive responses: 1. Have you ever fainted, passed out or had a seizure suddenly and without warning, especially during exercise or in response to auditory triggers such as doorbells, alarm clocks, and ringing telephones? 2. Have you ever had exercise induced chest pain or shortness of breath? 3. Are you related to anyone with sudden, unexplained and unexpected death before the age of 50? 4. Are you related to anyone who has been diagnosed with a sudden death-predisposing heart condition such as HCM, LQTS, Brugada syndrome? At the present time, the best method to identify those children at risk for SCA through primary screening remains controversial. Please feel free to discuss this during your visit or call our office to get information. Have a safe and fun sports season
Posted on: Tue, 15 Oct 2013 19:37:01 +0000
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