College and high school athletes are typically in top physical shape. Except a few have an invisible heart condition that can lead to sudden cardiac arrest, where they drop dead on the court or field.
A new study by a group of physicians led by a team doctor for the University of Washington Huskies recommends all student athletes get a high-tech heart scan called an electrocardiogram, or EKG.
The catch is their doctors probably need additional training.Currently, a standard sports physical includes a series of questions about shortness of breath and family history, and a stethoscope to the chest, but not an EKG.
Listening to the heart's electrical rhythm
If you head to the basement of the student health center on the UW campus, you’ll find the sports medicine clinic where Dr. Jonathan Drezner shows off a portable EKG machine.
"It basically looks like a laptop computer with some ... little stickers that attach to chest wall and arms and legs," says Drezner, who practices family and sports medicine, serves as a team doctor for the Huskies and the Seahawks, and is the president of the American Medical Society for Sports Medicine. Those stickers are electrical leads that measure the heart's electrical activity.
The EKG can detect problems in the heart that you can’t hear with a stethoscope. The test also can easily produce false alarms when applied to young athletes, which has made the test a subject of intense debate in the sports medicine community.
A young athlete’s heart grows and adapts to stress in ways that makes it different from your average heart. A healthy young heart can show signs on an EKG that look similar to distress in an older person.
New research on college athletes
Dr. Drezner and a group of physicians from 14 major colleges recently screened nearly 2,500 athletes. The EKG spotted five students who passed a normal physical with no inkling of trouble but had a hidden heart ailment. That works out to about two out of every thousand tested, similar to previous studies. Those students could potentially die in an intense workout that put high stress on the heart.
The research also found they could avoid false positives, as long as the doctors had special training. The risk of false positives is one of themain reasons for controversy over widespread use of EKGs.
"If you are a physician that is responsible for the care of athletes, and you are asked to screen an athlete to make sure they are safe to play, and you learn how to do an EKG in an accurate way, it can be incredibly valuable," says Drezner. And the idea is not too hard to implement, with a price tag of about $25 per test.
Dr. Drezner says he’s personally had to tell a few athletes to quit their main sport and try something easier on the heart, such as golf.
The study was commissioned and funded by the NCAA, and it could push all colleges to get their doctors trained and make an EKG standard for student athletes. The results were presented April 19t, at the AMSSM Annual Meeting.
The results also might apply to high school athletes, says Drezner, particularly those in sports with intense workouts. Previous studies have shown basketball players have the highest risk of sudden cardiac arrest.
