Report: Young Athletes Need Dual Screening for Heart Defects

(Ivanhoe Newswire) -- Life-threatening heart defects in young athletes need both popular screening programs for adequate diagnosis. Using just one test or the other could cause doctors to miss serious cardiac abnormalities.

Sudden cardiac death due to heart rhythm disturbances claims more than 3,000 young lives a year, especially among athletes who have inherited the tendency to develop enlarged and thickened hearts. The peak physical condition of top athletes can mask early warning signs and allow cases of heart defect to go undiagnosed.

Theodore Abraham, M.D., associate professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute and colleagues analyzed data from 134 top Maryland high school athletes screened during the 2008 track and field state championships. The researchers were looking for life-threatening cardiac abnormalities. None of the students in the study exhibited any symptoms.

Although abnormal findings were discovered in 36 student athletes, none was found to have life-threatening heart defects. Twenty-two of those abnormalities were found by EKG alone, nine by ECHO alone and five were picked up on both tests. Those with abnormalities -- which included 19 with high blood pressure, 29 with elevated blood pressure in need of future monitoring, and five with low blood pressure readings -- were referred for follow-up to their doctors.

"If you are going to screen, it has to be comprehensive," Abraham, who spearheads the annual "Heart Hype" screening program run by Johns Hopkins, was quoted as saying. Some screening programs just include EKGs and not ECHOs. "An EKG does show you a lot," said Abraham, "but it doesn't tell you the whole story. The advantage of a comprehensive screening is that it is holistic, rather than being pinpoint. For example, if a doctor were screening for prostate cancer, he wouldn't ignore a large tumor on your head."

Lead study investigator Aurelio Pinheiro, M.D., a postdoctoral research fellow at Hopkins, is quoted as saying he wasn't surprised he and his colleagues didn't find a student with a life-threatening heart abnormality, since it is estimated that only one in 500 Americans has undiagnosed hypertrophic cardiomyopathy and the Hopkins team screened fewer than that.

The screening program is designed not just to prevent deaths from sudden cardiac arrest, but also to raise awareness of the risks to young athletes.
Less pressing but still serious medical conditions were identified by the researchers, notably high blood pressure, which in teenagers, according to Pinheiro, can lead to later heart failure or kidney disease if left untreated.

In some nations, programs to screen teenagers for possible heart problems have been routine for years. Abraham disagrees with some U.S. health professionals who argue that doing expensive diagnostic tests such as the EKG and ECHO are not worth the cost, since sudden cardiac death in young people is relatively rare and mass screenings are unlikely to turn up large numbers of teens in immediate danger. "What is the price for a single life?" he asked. "We're counting the costs up front. We're not counting the savings on the downstream end."

Abraham continued, "Athletes and other teens should let someone know how they are feeling, especially if they have had chest pains, shortness of breath with activity or have fainted. This could save their life."

SOURCE: Presented at the American Heart Association Annual Scientific Sessions, Orlando, FL, November 15, 2009

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