How Important Are Cardiac Screenings For Athletes?

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A physical exam is a necessity before practice begins for any sport. But should that exam include a cardiac screening to identify possible problems with the heart? 

Yes, says Jeffrey James, DO. There’s no doubt that a cardiac screening is needed, he says. The debate, however, is what kind of cardiac screen should be done. Screenings typically include taking a personal history, a family history, and doing a cardiovascular exam which includes listening to the heart, checking pulses, and blood pressure monitoring. “The question is whether or not an EKG screening also should be done,” says Dr. James.

What Heart Issues Can Be Found During Basic Screenings?

Basic screenings can identify heart murmurs and abnormal pulses. And by getting a thorough history of the athlete and family, the physician will learn of any history of fainting, dizziness, or blackouts. Has a family member died of a heart-related issue? Is there a family history of abnormal heart rhythms or murmurs?

“There are a lot of different parts to the physical exam and history that can point us to some of these different pathologies,” Dr. James explains. “We’re looking for any kind of structural heart disease, anything that can lead to sudden cardiac arrest or sudden cardiac death in the athlete. Some of these diseases are genetic, like Marfan syndrome, which causes enlargement of the heart.”

What Issues Can Be Found With Advanced Screening?

Advanced cardiac screening, like an EKG, can identify issues not usually found during basic screenings. Dr. James explains what can be identified during an EKG.

Click play to watch the video or read video transcript.

Reading an EKG correctly can be tricky, says Dr. James. So it’s important that your EKG be examined by someone with extensive experience. “What is normal in children may be abnormal in teens. So for those who are not experienced in understanding electrical and structural changes with the heart, an EKG result may seem abnormal when it is actually normal,” Dr. James explains. “This can lead to a lot of false positive readings and can cause a lot of lost time in the sport. A false reading also can cause a lot of stress and worry for the athlete and family.”

If an EKG shows any abnormalities, a visit with a cardiologist will be needed. The cardiologist will confirm the abnormality and decide if additional testing is needed. This may include an echocardiogram, ultrasound of the heart, or a stress test while monitoring heart rhythms.

Should All Student Athletes Undergo Advanced Cardiac Screening?

“As far as doing advanced screening on every athlete, the jury and debate is still out,” Dr. James says. “We don’t know if the benefits truly outweigh the risk of screening everyone.”

But he does recommend advanced screening for anyone who has “red flags,” such as family or personal history of heart disease or has had concerning symptoms, such as chest pain during exertion.

Dr. James explains considerations for advanced cardiac screening for student athletes.

Click play to watch the video or read video transcript.

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