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Young Athletes and Evaluating the Use of Electrocardiograms

Author: CHKD Sports Medicine
Published Date: Thursday, January 28, 2016

By: Tori Faulkner, MS, CES

Although rare, sudden cardiac death (SCD) is the most common cause of death in athletes. SCD is defined as an abrupt, unexpected death due to a cardiovascular cause. It is generally recognized as death that occurs within one hour from the onset of cardiovascular symptoms. However, in young people, it can occur within minutes from the onset of symptoms and sports participation has been associated with an increased risk of SCD. A preventive measure may be to use electrocardiograms.

What causes SCD?

In most cases of SCD a cardiac abnormality is at fault, like atypical arrhythmias. Sometimes, a genetic disorder is to blame, most common being hypertrophic cardiomyopathy or coronary artery anomalies. All SCD episodes have different origins but share similar pathways. Heart signals become chaotic causing an abnormal electrical rhythm and the heart beats out of control, known as ventricular fibrillation.

Can it be prevented?

Signs preceding the events may include fatigue, fainting, dizziness, chest pain, shortness of breath, weakness, or palpitations, but often occur without warning. Therefore, cardiovascular screenings for conditions that lead to an increased risk of SCD have focused on the pre-participation evaluation of athletes. In the U.S., current recommendations focus on personal and family history. Sill this may not show any red flags. An electrocardiogram (ECG) is a simple test that looks at the electrical activity of the heart by placing 12 electrical leads on the chest and torso.

ECG leadsWho should be screened for risk factors?

Recently an intense debate has been occurring over the effectiveness of ECG screening for athletes. For the last 25 years in Italy all athletes have undergone ECG screenings, with data indicating fewer deaths during athletic events. This reduction of SCD events is also related to disqualification of more young people whose ECG’s showed heart abnormalities. The current U.S. recommendations are against ECG screenings due to the large number of athletes that would require them. Cost of an ECG, its interpretation, in addition to further testing due to frequent false-positives, have resulted in an unfavorable cost-benefit ratio.

What can be done now?

Although rare in the young population, SCD can happen, and is important find those at risk. Some important considerations and actions that can be taken right now include:

  • Recognizing the warning signs and symptoms of SCD
  • Using standardized pre-participation evaluation forms and processes
  • Ensuring those with known or suspected cardiac disorders are referred to a pediatric cardiac center for a comprehensive evaluation
  • Support educational programs for effective bystander CPR and AED use
  • Participation in school emergency response programs

  • References:

    • Campbell, R., Berger, S., Ackerman, M. Pediatric Sudden Cardiac Arrest. American Academy of Pediatrics. 2012; 0144
    • Khan, B. Sudden Cardiac Arrest in Kids: What and Why? Sudden Cardiac Arrest Foundation. 2015.
    • Liberthson, R. Sudden Death from Cardiac Causes in Young Children and Adults. N Engl J M. 1996; 334:1039-1044
    • Link M., Estates III, M. Sudden Cardiac Death in the Athlete Bridging the Gaps Between Evidence, Policy and Practice. American Heart Association. 2012; 125:2511-2516

    About CHKD Sports Medicine

    CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.