Preventing Sudden Cardiac Arrest In Young Athletes
We have all heard about, or been affected by, a sudden cardiac arrest (SCA) of a young athlete during play or practice. If your child plays a school sport, you have most likely had to sign a form acknowledging that you know this risk exists. While this is an uncommon event, it can happen and is absolutely devastating when it occurs. Most sudden deaths in athletes are caused by underlying heart conditions that can lead to sudden cardiac arrest (SCA), which means the heart rhythm goes into an abnormal heart rhythm and then the heart stops beating. These underlying heart conditions may not cause obvious symptoms before the SCA event, so there are often no warning signs of a problem.
So what can we do to prevent these events?
First of all, we know that we cannot prevent all cases of sudden cardiac arrest. There are many variables and currently we do not have practical methods to identify all of those who may be at risk. But, there are things we can do to improve earlier diagnosis and management of underlying cardiac issues that can cause sudden cardiac arrest. And having AED’s in place along with trained staff to deal with sudden cardiac arrest during athletic events will always be key to improving survival when events do occur.
Every young athlete should have a pre-participation examination with their primary care doctor that includes a thorough history with includes the following…
-Has the athlete had unexplained dizziness or fainting with exercise or associated with loud noises?
-Does the athlete have chest pain or shortness of breath (out of proportion to activity) with exercise?
-Is there a family history of sudden cardiac death before the age of 50?
-Are there family members who have a cardiomyopathy (inherited heart muscle problem) or an abnormal rhythm?
If the answer is “yes” to any of these questions, then a consultation with a pediatric cardiologist or a cardiologist trained to evaluate specifically for sports-related cardiac issues is recommended.
For those who want to have an additional layer of assurance, an ECG and echocardiogram can be obtained to identify some of the more common causes of sudden cardiac arrest. This testing should be done by a pediatric cardiologist or specially trained adult cardiologist to ensure that the testing is accurate. A pediatric echocardiogram involves comprehensive imaging that is often not included in a routine echocardiogram performed on an adult.
At Memphis Pediatric Heart, we offer these tests and perform them specifically to screen for known causes of SCA. Both tests are noninvasive and painless. An ECG can be done in about 5 minutes and an echocardiogram can be done in about 30-40 minutes. Both are done in office without having to go to a hospital. They are performed by specially trained staff and interpreted by a board-certified pediatric cardiologist.
Frequently Asked Questions
1.What is included in a cardiac sports screening?
This screening includes a complete echocardiogram (heart ultrasound), with special attention to the causes of sudden cardiac arrest (discussed below). This is somewhat different from a standard adult echocardiogram because of additional imaging. An electrocardiogram (ECG) is also performed to evaluate the heart electrical system. Results will be made available through portal. If there are abnormalities, these will be addressed with a full consultation if needed at a later visit.
2. Who is eligible for the screening?
Cardiac sports screenings are for young athletes who do not have any symptoms or significant family history of heart disease. There ar
3. How much does the testing cost?
Cost for the echocardiogram and ECG is $500. We also offer an ECG only option for $75 (results communicated with parent after visit through portal). This type of elective testing is not covered by insurances for patients without symptoms.
4. Does this screening detect all causes of sudden cardiac arrest?
No. There are some cases of sudden cardiac arrest that cannot be detected on this screening.
5. What cardiac conditions can be found on screening?
This is an abnormal thickening of the heart muscle, specifically in the ventricles (pumping chambers). Hypertrophic cardiomyopathy can cause arrhythmias (abnormal heart rhythms) or problems with pumping enough blood for exercise.
-Abnormal origin of coronary artery
This involves a coronary artery (supplies blood to the heart muscle) that can become compressed or blocked with exercise, causing poor blood flow to the heart muscle (similar to a heart attack).
-Congenital heart defects
The majority of severe heart defects would typically be diagnosed before the age of playing sports. However, there are some that can go undiagnosed without screening.
-Aortic aneurysm
This is an abnormal enlargement of the aorta (the main blood vessel that takes blood away from heart).
-Other cardiomyopathies.
There are other cardiomyopathies other than hypertrophic cardiomyopathy that aren’t as common. These often cause the heart to be enlarged, but the heart muscle is thin. These can be detected by echocardiogram screening.
-Wolff-Parkinson-White Syndrome
This is an electrical conduction abnormality in the heart that can lead to an abnormal heart rhythm (supraventricular tachycardia or ventricular tachycardia/fibrillation).
-Long QT syndrome
Another electrical conduction abnormality in the heart that can lead to an abnormal heart rhythm (ventricular tachycardia).
-Other heart rhythm abnormalities
5. Can my child return to play if these conditions are found?
The goal of identifying these underlying issues is first and foremost to protect the athlete from unnecessary risk of SCA. However, ideally we all want to see athletes return to playing sports safely. Many of these abnormalities can be corrected/managed with surgery, intervention, or medication that allows athletes to return to play. However, some findings can lead to a need to change or restrict sports participation because the risk of playing that sport may be too high, even with management. There are also times when the decision to play a particular sport is a judgment call and is made in conjunction with the athlete and their family, accepting that there is some risk involved.