Young athletes need dual screening tests for heart defects, study suggests

Nov 15, 2009

To best detect early signs of life-threatening heart defects in young athletes, screening programs should include both popular diagnostic tests, not just one of them, according to new research from heart experts at Johns Hopkins.

Sudden cardiac death due to rhythm disturbances is blamed for more than 3,000 deaths a year in young people, especially athletes who have inherited tendencies to develop overly enlarged and thickened hearts, says Theodore Abraham, M.D., an associate professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute. In some instances, top athletes have died from heart conditions while seemingly in peak physical form, something that can hide warning signs and allow many cases to go undiagnosed.

In a study to be presented Nov. 15 at the American Heart Association's (AHA) annual Scientific Sessions in Orlando, Abraham and colleagues analyzed data from 134 top Maryland high school athletes that they screened at the 2008 track and field state championships. The researchers were looking for life-threatening cardiac abnormalities, such as hypertrophic cardiomyopathies. Doctors took a medical history, took weight and measurements and listened for unusual heartbeats or murmurs. They also conducted an echocardiogram — a cardiac ultrasound, or ECHO — to measure heart size and pumping function and to check for faulty heart valves; and an electrocardiogram, or EKG, to assess the heart's electrical rhythms.

None of the student athletes were found to have life-threatening , but abnormal findings were discovered in 36 athletes. 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," says Abraham, who spearheads the annual "Heart Hype" screening program run by Johns Hopkins, and designed to serve as a national model for other leading academic medical centers. Some screening programs just include EKGs and not ECHOs. "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."

For example, if a doctor were screening for prostate cancer, "he wouldn't ignore a large tumor on your head," Abraham says.

Lead study investigator Aurelio Pinheiro, M.D., a postdoctoral research fellow at Hopkins, says he wasn't surprised that he and his colleagues didn't find anyone with a life-threatening heart abnormality since it is estimated that one in 500 Americans has undiagnosed hypertrophic cardiomyopathy and the Hopkins team screened fewer than that. Still, he says, the screening program is not just designed 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 also were found by the researchers, notably high blood pressure, which in teenagers, Pinheiro says, can lead to heart failure or kidney disease 10 or 15 years in the future if left untreated. He adds that two of the track stars examined were obese, which can lead to other health risks in the future if not taken care of.

During this year's screening program, doctors found a serious undiagnosed valve disease in one athlete and found another suffering from a condition they didn't know about that could likely mean a heart transplant in the future. The students had no symptoms.

In some nations, programs to screen teenage athletes and non-athletes for possible heart problems have been routine for years. In 2004, the International Olympic Committee recommended that all athletes be EKG-tested every two years for potential heart abnormalities, regardless of whether they have a history of cardiac trouble. The U.S. Olympic Committee offers voluntary cardiac screening.

Other screening programs have used just EKG and not ECHO, which the study suggests will miss some heart problems.

Some argue that doing expensive diagnostic tests such as the EKG and ECHO are not worth the costs since in young people is relatively rare and mass screenings are unlikely to turn up a large number of teens in immediate danger.

Abraham disagrees. "What is the price for a single life?" he asks. "We're counting the costs upfront. We're not counting the savings on the downstream end."

"They're still teenagers. They think and feel like they're at the top of the world," Abraham says. " 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: Johns Hopkins Medical Institutions

Explore further: Oil-swishing craze: Snake oil or all-purpose remedy?

add to favorites email to friend print save as pdf

Related Stories

Heart checks urged for athletes

Oct 04, 2006

Italian researchers say making young athletes undergo mandatory heart checkups may establish their risk for sudden cardiac death.

Positive exercise testing in athletes: What does that mean?

Sep 02, 2008

Sudden cardiac death (SCD) during sports activity is an uncommon, but catastrophic event. Different efforts to reduce the risk of SCD related to sports have been undertaken. What is the role of the exercise test in this context? ...

Sperm donor passed on sudden death heart defect

Oct 20, 2009

(AP) -- A sperm donor passed on a potentially deadly genetic heart condition to nine of his 24 children, including one who died at age 2 from heart failure, according to a medical journal report.

Recommended for you

AMA examines economic impact of physicians

11 hours ago

(HealthDay)—Physicians who mainly engage in patient care contribute a total of $1.6 trillion in economic output, according to the American Medical Association (AMA)'s Economic Impact Study.

Less-schooled whites lose longevity, study finds

11 hours ago

Barbara Gentry slowly shifts her heavy frame out of a chair and uses a walker to move the dozen feet to a chair not far from the pool table at the Buford Senior Center. Her hair is white and a cough sometimes interrupts her ...

How to keep your fitness goals on track

11 hours ago

(HealthDay)—The New Year's resolutions many made to get fit have stalled by now. And one expert thinks that's because many people set their goals too high.

Suddenly health insurance is not for sale

Apr 18, 2014

(HealthDay)— Darlene Tucker, an independent insurance broker in Scotts Hill, Tenn., says health insurers in her area aren't selling policies year-round anymore.

User comments : 0

More news stories

Cancer stem cells linked to drug resistance

Most drugs used to treat lung, breast and pancreatic cancers also promote drug-resistance and ultimately spur tumor growth. Researchers at the University of California, San Diego School of Medicine have discovered ...

Poll: Big Bang a big question for most Americans

Few Americans question that smoking causes cancer. But they have more skepticism than confidence in global warming, the age of the Earth and evolution and have the most trouble believing a Big Bang created the universe 13.8 ...

Making graphene in your kitchen

Graphene has been touted as a wonder material—the world's thinnest substance, but super-strong. Now scientists say it is so easy to make you could produce some in your kitchen.