Preventing Sudden Cardiac Arrest In Young Athletes
We have all heard about, or been affected by, a sudden cardiac arrest (SCA) of a young athlete during play or practice. If your child plays a school sport, you have most likely had to sign a form acknowledging that you know this risk exists. While this is an uncommon event, it can happen and is absolutely devastating when it occurs. Most sudden deaths in athletes are caused by underlying heart conditions that can lead to sudden cardiac arrest (SCA), which means the heart rhythm goes into an abnormal heart rhythm and then the heart stops beating. These underlying heart conditions may not cause obvious symptoms before the SCA event, so there are often no warning signs of a problem.
There is still a lot we don’t understand about the how and why of these events, but here is some of what we do know…
-The incidence of these events is very rare, but obviously devastating when it occurs.
-Males are affected at a significantly higher rate than females.
-African-American basketball players are the subgroup at the highest risk (although still rare).
-There are various potential underlying cardiac problems that can increase the risk of sudden cardiac arrest, but there are still a significant number of events that are associated with structurally normal hearts and challenging to definitively explain.
-The leading causes of sudden cardiac arrest (of those that are known) are hypertrophic cardiomyopathy, coronary artery abnormalities, and genetically inherited arrhythmias.
-Electrocardiograms (ECG) and echocardiograms can identify structural abnormalities and some who have predisposition for arrhythmia, but there are still some athletes at risk who would not be identified with this testing.
-The presence of an automated external defibrillator on-site at athletic events, as well as staff trained to perform CPR and use the AED is of utmost importance in increasing survival rates (as seen in recent events).
So what can we do to prevent these events?
First of all, we know that we cannot prevent all cases of sudden cardiac arrest. There are many variables and currently we do not have practical methods to identify all of those who may be at risk. But, there are things we can do to improve earlier diagnosis and management of underlying cardiac issues that can cause sudden cardiac arrest. And having AED’s in place along with trained staff to deal with sudden cardiac arrest during athletic events will always be key to improving survival when events do occur.
Every young athlete should have a pre-participation examination with their primary care doctor that includes a thorough history with includes the following…
-Has the athlete had unexplained dizziness or fainting with exercise or associated with loud noises?
-Does the athlete have chest pain or shortness of breath (out of proportion to activity) with exercise?
-Is there a family history of sudden cardiac death before the age of 50?
-Are there family members who have a cardiomyopathy (inherited heart muscle problem) or an abnormal rhythm?
If the answer is “yes” to any of these questions, then a consultation with a pediatric cardiologist or a cardiologist trained to evaluate specifically for sports-related cardiac issues is recommended.
For those who want to have an additional layer of assurance, an ECG and echocardiogram can be obtained to exclude some of the more common causes of sudden cardiac arrest. This testing should be done by a pediatric cardiologist or specially trained adult cardiologist to ensure that the testing is accurate. A pediatric echocardiogram involves comprehensive imaging that is often not included in a routine echocardiogram performed on an adult.
At Memphis Pediatric Heart, we provide these tests that screen for some of the known causes of sudden cardiac arrest. It is important to know that according to the data we have currently, about 60-75% of those at risk can be identified with these tests. There are some at risk that we do not have the ability to identify with simple testing at this time. If one of these conditions is discovered, appropriate management and treatment can then be implemented to prevent SCA. It is important to know that in order for this testing to be effective in screening, it needs to be done under the guidance of a pediatric cardiologist or a cardiologist specifically trained to evaluate for these conditions.
Frequently Asked Questions
1. What is included in a cardiac sports screening?
-This screening includes a complete echocardiogram (heart ultrasound), with special attention to the causes of sudden cardiac arrest (discussed below). This varies from a standard adult echocardiogram because of additional imaging. An electrocardiogram (ECG) is also performed to evaluate the heart electrical system. No consultation with a provider is included in the screening. Results will be called to the patient’s family and results emailed. If there are abnormalities, these will be addressed with a full consultation if needed at a later visit.
2. Who is eligible for the screening?
-Cardiac sports screenings are for young athletes who do not have any symptoms or significant family history of heart disease. The ideal age is 12-21 years old. Patients who have a significant family history of heart disease or symptoms of chest pain, shortness of breath, palpitations, or fainting with exercise need to schedule a consultation with cardiology (as recommended by the American Academy of Pediatrics).
3. How much does the testing cost?
Cost for the echocardiogram and ECG is $500. This type of elective testing is not covered by insurances for patients without symptoms. A standard consultation appointment is recommended for those with symptoms, as these evaluations are typically eligible for insurance coverage.
4. Does this screening detect all causes of sudden cardiac arrest?
No. There are some cases of sudden cardiac arrest (abnormal rhythms, adult-type coronary artery disease, commotio cordis) that cannot be detected on this screening.
5. What cardiac conditions can be found on screening?
This is an abnormal thickening of the heart muscle, specifically in the ventricles (pumping chambers). Hypertrophic cardiomyopathy can cause arrhythmias (abnormal heart rhythms) or problems with pumping enough blood for exercise.
-Abnormal origin of coronary artery
This involves a coronary artery (supplies blood to the heart muscle) that can become compressed or blocked with exercise, causing poor blood flow to the heart muscle (similar to a heart attack).
-Congenital heart defects
The majority of severe heart defects would typically be diagnosed before the age of playing sports. However, there are some that can go undiagnosed without screening.
-Aortic aneurysm
This is an abnormal enlargement of the aorta (the main blood vessel that takes blood away from heart).
-Other cardiomyopathies.
There are other cardiomyopathies other than hypertrophic cardiomyopathy that aren’t as common. These often cause the heart to be enlarged, but the heart muscle is thin. These can be detected by echocardiogram screening.
-Wolff-Parkinson-White Syndrome
This is an electrical conduction abnormality in the heart that can lead to an abnormal heart rhythm (supraventricular tachycardia or ventricular tachycardia/fibrillation).
-Long QT syndrome
Another electrical conduction abnormality in the heart that can lead to an abnormal heart rhythm (ventricular tachycardia).
-Other heart rhythm abnormalities
5. Can my child return to play if these conditions are found?
The goal of identifying these underlying issues is first and foremost to protect the athlete from unnecessary risk of SCA. However, ideally we all want to see athletes return to playing sports safely. Many of these abnormalities can be corrected/managed with surgery, intervention, or medication that allows athletes to return to play. However, it is important to know that some findings can lead to a need to change or restrict sports participation because the risk of playing that sport may be too high, even with management. There are also times when the decision to play a particular sport is a judgment call and is made in conjunction with the athlete and their family, accepting that there is some risk involved.