Dual Heart Tests Best for Young Athletes
When Screening for Heart Defects, 2 Tests Better Than 1
By
Charlene Laino
WebMD Health News
Reviewed By
Louise Chang, MD
Nov. 18, 2009 (Orlando) -- Young athletes should be screened with two common
heart tests, not just one -- or early signs of life-threatening heart defects
may be missed, researchers report.
"The chance of finding an abnormality is rare, but if it is missed, the
consequences are catastrophic," says Theodore Abraham, MD, an associate
professor at the Johns Hopkins University School of Medicine's Heart and
Vascular Institute.
The two heart tests are an echocardiogram, or ECHO, which measures
heart size and pumping function and checks for faulty heart valves, and an
electrocardiogram, or EKG, which assesses the heart's electrical rhythms.
Each year in the U.S., more than 3,000 people aged 15 to 34 succumb to
sudden cardiac death as a result of heart rhythm disturbances, Abraham
says.
Athletes who have inherited tendencies to develop overly enlarged and
thickened hearts are particularly at risk, he says.
Many fall victim with little or no warning. Fans often express shock when
star athletes, like Reggie Lewis of the Boston Celtics, collapse and die
despite seemingly being in peak physical form, he says.
"Studies have shown that screening all athletes is not cost-effective, so we
wanted to see if there was a way we could refine the screening process,"
Abraham tells WebMD.
Dual Heart Tests Pick Up More Problems
The new study, presented at the annual meeting of the American Heart
Association, involved 134 Maryland high school athletes participating in the
2008 track and field state championships.
The researchers were looking for life-threatening cardiac abnormalities such
as hypertrophic cardiomyopathy, a condition in which the heart muscle thickens
abnormally and whose patients often have no symptoms.
"We did a very focused exam. First, we took a 10-minute medical history,
then we took weight and blood pressure measurements. Using a stethoscope, we
listened for unusual heartbeats or murmurs. Then, we conducted an
echocardiogram and an EKG," Abraham says.
None of the student athletes was found to have life-threatening heart
defects, but 36 exhibited abnormal findings on ECHO or EKG. Twenty-two
abnormalities were detected by EKG alone, nine by ECHO alone, and five were
picked up on both tests.
"If we had only done the ECHO or the EKG, a significant number of
abnormalities would have been missed," Abraham says.
"If you are going to screen, it has to be comprehensive. An EKG does show
you a lot," he says, "but it doesn't tell you the whole story. The advantage of
a comprehensive screening is that it is holistic, rather than being
pinpoint."
Aurelio Pinheiro, MD, a postdoctoral research fellow at Johns Hopkins who
also worked on the study, wasn't surprised that none of the athletes had a
life-threatening heart abnormality as so few patients were screened.
"But with larger numbers, life-threatening conditions would be missed,"
Abraham says.
Athletes with abnormalities -- which included 19 with high blood pressure,
29 with slightly elevated blood pressure, and five with low blood pressure
readings -- were referred to their doctors for follow-up.
In some nations, including Italy, federal law mandates screening of young
athletes, he says. "That's probably not going to happen here, but we do need
better programs," he says.
In the meantime, Abraham urges any athlete with abnormal symptoms, no matter
how trivial they seem, to consult their coach or doctor.
"Let someone know how you are feeling, especially if you have had chest
pains, shortness of breath, or have fainted." he says. "This could save your
life."
Michael Sayre, MD, associate professor of emergency medicine at Ohio State
University in Columbus, agrees that screening of athletes is important.
But he tells WebMD that he also worries that too much testing could have
negative consequences.
"One in four athletes in the study had abnormal test results, but none had
significant problems. There's a risk the tests could identify people who don't
have problems. They may worry unnecessarily or choose not to participate in
sports when they shouldn't," he says.
SOURCES:American Heart Association Scientific Sessions 2009, Orlando, Nov. 15-19,
2009.
Theodore Abraham, MD, associate professor, Johns Hopkins University School
of Medicine's Heart and Vascular Institute.
Aurelio Pinheiro, MD, Johns Hopkins.
Michael Sayre, MD, associate professor, emergency medicine, Ohio State
University, Columbus.
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