Between 200 and 300 young people die each year while playing sports. In many cases, the underlying health condition that led to death could have been identified by a pre-sports medical exam.
Some of the sudden deaths are caused by injury, heat stroke, asthma, or other causes. More than half of them can be traced to cardiac arrest — the sudden cessation of a normal heartbeat and blood circulation. The most common cause in these cases is hypertrophic cardiomyopathy, an inherited condition in which the heart muscle becomes disorganized and thick. Individuals born with coronary arteries that are abnormally connected to the heart are also at risk of sudden death. Heart infection or inflammation and a host of less common conditions, such as Marfan syndrome and long QT syndrome, can also spark cardiac arrest during sports.
Although sudden death happens most often in football (30 percent of these deaths), basketball (22 percent), soccer (6 percent), and baseball (6 percent), it also happens to swimmers, lacrosse players, rowers, gymnasts, figure skaters, golfers, and other athletes.
What should screening entail?
The American Heart Association (AHA) recommends that all young athletes have a checkup that covers a dozen key points. The European Society of Cardiology goes a step further, recommending that athletes also have an electrocardiogram (ECG). This simple test can pick up irregularities in the heart's rhythm that could mean trouble.
Who needs screening?
Any young person who intends to play a physically demanding sport or do strenuous exercise ought to have a pre-participation checkup that includes the AHA's 12 points. Ideally, it would be done by a physician familiar with sports medicine or athletes.
For competitive athletes older than 35, the AHA recommends that a clinician probe for a personal history of risk factors for coronary artery disease. An exercise stress test and additional cardiovascular testing might be warranted in men over 40 and women over 55 who have two coronary risk factors before they engage in competitive sports or a vigorous training regimen.
Doctor's checklist for heart health
During the personal history, any of the following should prompt a more thorough evaluation:
• chest pain or discomfort with exertion
• unexplained fainting or near-fainting, especially when related to exertion
• excessive shortness of breath or fatigue associated with exercise
• a previously diagnosed heart murmur
• elevated blood pressure
During the family history, any of the following should prompt a more thorough evaluation:
• death before age 50 (sudden and unexpected, or otherwise) in a close relative
• disability from heart disease in a relative under age 50
• knowledge of cardiac conditions in family members, such as hypertrophic or dilated cardiomyopathy, long QT syndrome, Marfan syndrome, or clinically important arrhythmias
The physical exam should include these steps:
• listening to the heart to identify any heart murmur
• checking the femoral pulses in the groin
• looking for the physical signs of Marfan syndrome
• checking blood pressure at the brachial artery in both arms
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