From Our Archives
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
September 2007 - The risk of an athlete dying of a heart problem during exercise is little more than one in a million, but within the last month, three elite soccer players died while playing. Antonia Puerta had a heart attack in the middle of a game in front of a stadium full of fans in Seville, Italy, at the age of 22. Chaswe Nsofwa died while practicing in Israel, and Anton Reid, a 16-year-old professional soccer player, collapsed in the middle of a game in England.
Young people aren't supposed to die. Young people aren't supposed to have heart attacks. Elite athletes are supposed to have finely tuned bodies that are the envy of every armchair quarterback in front of their television set. We tune in to see the thrill of victory and the agony of defeat, but not the morbidity of death.
Every fall, the sports participation physical comes home with students, and parents grumble about having to see a doctor to get it filled out just to let their aspiring athlete suit up. The family doctor does a cursory check, signs the paper and everybody is good to go. But is there a better way?
The annual meeting of the European Society of Cardiology was recently held in August 2007. The Italians and Americans differ in what is required to allow kids to play sports. For the past 25 years, all athletes in Italy have been required to have a heart screening assessment, which includes a family and personal history, physical examination, and electrocardiogram. With these measures, sudden cardiac deaths have fallen from four per 100,000 to one-tenth of that. Italian researchers and cardiologists believe that this standard should be accepted worldwide.
Doctors in other countries aren't so sure. At the American College of Cardiology meetings in 2006, Drs. Estes and Zipes discussed the controversies in screening athletes. They pointed out that the Italian studies dealt with relatively homogeneous populations and the doctors were well trained in screening adolescent athletes. They argued that the U.S. has a more diverse population, and that history and physical examination are adequate screening tools. Dr. Estes wrote, "Currently, EKGs are not advocated, and there is only selective use of stress test and echocardiograms...The cost per diagnosis when it's been looked at for screening in the United States is prohibitive; it's hundreds of thousands of dollars per patient identified."
It seems that it always comes down to money, and it may be too expensive to save a handful of lives each year. The risk is relatively minimal for high school students, but gradually increases as the athlete gets older, so that the risk for a senior citizen athlete may be 50 times greater than of a teenager. But statistics are only good for talking about lots of people. How does a parent decide what is right for their son or daughter? One in a million doesn't mean much unless your child happens to be the one.
It's now September and time for those participation forms to be turned in. It doesn't matter who's more right, Italians or Americans. The lesson to be learned from the death of three elite athletes is that the screening exam shouldn't be considered an inconvenience; it may be a matter of life or death.