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Should young athletes undergo cardiac screening before participating in sports?

Sudden cardiac death (SCD) in young athletes is a rare and tragic event. It has a devastating and highly emotional impact on families and the community. Yet, there is controversy regarding screening young athletes to identify those at high risk of sudden death. Should young athletes undergo cardiac screening before participating in sports? On Nov. 19, 2013, the New England Journal of Medicine published a “Clinical Decisions” article presenting four experts' opinions on this controversial topic. The results of this discussion will be coordinated with a live debate at the American Heart Association (AHA) annual meeting on Nov. 20, 2013. Review of arguments, voting, and discussion are open to readers of the New England Journal of Medicine through Dec. 4, 2013.

Sudden cardiac death is a rare event in athletics. Studies show that the current status of pre-participation cardiovascular screening of high school and college athletes nationwide is poor.
Sudden cardiac death is a rare event in athletics. Studies show that the current status of pre-participation cardiovascular screening of high school and college athletes nationwide is poor.
Anita P. Kuan, Sources: NEJM; NIH
Cardiac screening before participation in sports
Anita P. Kuan/MClipArt

The risk of SCD among teenagers and young adults engaged in athletic competition has been estimated at three times the risk among their non-athletic counterparts. "Socially this is a major issue. The victims are in shape, trim, firm and healthy. It’s a shock to people," said Dr. Peter Schulman, cardiologist at the University of Connecticut Medical School.

In Connecticut, Eboni McCotter of New Haven died at the age of 13 after finishing basketball practice with the Connecticut Starters. Michael Sage suffered a fatal sudden cardiac arrhythmia; he was active in sports for most of his life and played baseball and basketball for the town of Hamden. The death of Boston Celtic forward Reggie Lewis during a workout three years after Loyola Marymount forward Hank Gathers died of a similar heart condition drew attention to the issue of SCD in young athletes. Researchers and sports medicine practitioners implemented a variety of methods to improve the often controversial “sports physical.” But, the approaches varied. Both the AHA and the European Society of Cardiology (ESC) agree on the need for cardiovascular evaluation of young athletes before they participate in competitive sports. But, there is vigorous debate regarding the inclusion of the electrocardiogram (ECG or EKG; an EKG records the electrical signals present in the heart) in the screening protocol, in addition to a medical history and physical examination.

So, should young athletes undergo cardiac screening before participating in sports? In the New England Journal of Medicine, experts in the field weigh in and present arguments on:

  • Question 1: Should young athletes be required to undergo cardiac screening before participation in sports?
  • Question 2, Should cardiac screening for young athletes before participation in sports include an EKG (in addition to a History and Physical Examination)?

See photos in the accompanying slide show above for summaries of the experts’ arguments.

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