Pre-Sports Participation Screening: What You Need to Know – U.S. News & World Report

The sudden death of an athlete is a rare, but tragic event that often commands national attention. Each year in the United States, as many as 100 deaths occur on the playing field due to an unexpected heart condition. These tragic losses can cause confusion and fear for parents whose kids participate in sports, but it is important to understand the real risks before reconsidering a young athlete’s participation in sporting activities.

The heart conditions found in young athletes are different from the coronary artery diseases that lead to heart attacks and sudden death in older adults. They are commonly related to an inherited disease of the heart muscle, a congenital malformation of the valves or arteries of the heart, or an abnormal heart rhythm. Screening is a process designed to identify athletes who might have a heart condition and warrant further heart testing. Screening is designed to cast a wide net; thus, even when a screen is positive, it is much more likely that the heart will be found to be normal than a rare heart condition will be diagnosed.

What Is Screening and When Is it Done?

Screening for heart conditions is recommended prior to participation in competitive sports and is usually performed between 12 to 15 years of age. It’s also commonly performed again prior to participation in competitive college athletics. The primary care physician or team doctor conducts the screening, which includes questions about symptoms of heart disease, a family history looking for inherited heart diseases and a physical examination looking for signs of heart disease. Symptoms of heart diseases include: exercise-related chest pain, trouble breathing, dizziness or fainting. Symptoms of abnormal heart rhythms include: irregular or fast heart beats, associated with dizziness or fainting, that can happen both with exercise and at rest. Heart abnormalities on physical examination include: high blood pressure, abnormal heart sounds or abnormal heart rhythms.

What Happens if the Screening Is Positive?

If the screening questions and exam raise any concerns, a referral to a pediatric cardiologist is made for further evaluation. Before the visit to the cardiologist, it’s helpful to gather more details about heart diseases in the family, particularly looking for relatives with the following: sudden death at a young age (less than 30 years old), early heart disease (less than age 50 in women and age 55 in men), unexplained seizures, congenital deafness, heart rhythm problems, an enlarged heart or unexplained fainting episodes (“syncope”), particularly during exercise or at times of high emotion.

During the evaluation, the cardiologist will ask more questions looking for symptoms of heart disease and will perform a physical examination looking for signs of heart diseases, such as high blood pressure, heart murmurs or abnormal heart sounds. An electrocardiogram (EKG or ECG) is performed to look at the rhythm of the heart and detect if one part of the heart is larger than normal or in an unusual position. If an abnormality is found, other heart tests will be performed to help diagnose or rule out heart disease. Common tests include:

• Echocardiogram (“echo”): Sound waves are used to generate pictures of the heart chambers and valves. Moving images of the heart are taken that give the cardiologist important information about the structure of the heart – how strong the heart muscle pumps, how big the chambers of the heart are and how the heart valves are working. An echo can also see coronary arteries (the arteries that supply oxygen to the heart), and whether they connect normally.
• Exercise test (“stress test”): This test involves running on a treadmill or riding an exercise bicycle (stationary bike) similar to those found in health clubs, while the ECG and blood pressure are monitored. A stress test gives the cardiologist important information about physical endurance and can detect abnormal heart rhythms or abnormal blood pressures during exercise.
• Holter/event monitor: This test involves continuously monitoring the ECG for at least 24 hours and up to one month. This allows detection of abnormal heart rhythms that are not present all the time, but happen off and on.
• Cardiac magnetic resonance imaging (CMR): This test uses a magnetic field to image the heart in sections. This creates a three-dimensional image of the heart that is used to evaluate the size and function of the heart and detect problems with the valves or arteries of the heart.

What Happens if a Heart Condition Is Discovered?

Depending on the type and severity of the heart condition that’s diagnosed, more testing may be needed to decide on the appropriate treatment and whether to limit sports participation. For mild conditions, periodic follow-up visits with the cardiologist may be needed, but there will be no restrictions to sports participation. For other conditions, sports participation may be restricted until further evaluation and treatment are complete. For the most serious conditions, patients may be restricted from certain sports activities indefinitely.

It’s important to remember that most children who have a positive screen will have a normal heart evaluation and a healthy heart. Furthermore, many heart conditions are treatable and do not limit sports participation. If a heart condition is found, the cardiologist will make every effort to recommend the level of physical activity that will keep the patient safe, while addressing the desire for an active lifestyle.