Sudden Cardiac Arrest and Sports

I am very sorry to hear you lost your son. If you are looking for heart screenings to be approved, find some like-minded people to join you in your efforts. Then, find a cardiologist who is most likely to be sympathetic to young people. I’d suggest one who has children, or has volunteered as a coach. A pediatric cardiologist may also be more likely to come out to assist. If you call large cardiology groups, you may be more likely to find someone willing. My other suggestion is that you work toward providing a voluntary program that encourages students to be screened at a reduced or no cost, rather than mandating the screenings. Once school officials and parents see the value of the program, they are more likely to repeat or expand it in future years.

Lots of studies correlate particulate matter (air pollution) as a trigger for cardiac events. Regarding forest fires specifically, people with prior history of myocardial infarction (MI, heart attack) are at increased risk for a second MI during a forest fire. Knowing that SCA is often caused my acute MIs, I would have to say the answer to your question is “yes”.

At this point, I would have to say no. See item number 8 where I discuss extensively for Rick.

Hi Joan. It is so wonderful that Mike survived! Dizziness is problematic for physicians because it can have many causes. Before thinking this was related to the central nervous system, I’d wonder about the following: Is it related to medication? Is the pacemaker portion of the ICD “kicking in”, causing brain to feel the difference in the amount of blood ejected by the heart from the artificial beat of the pacemaker? It is certainly something to discuss with Mike’s doctors, especially those who check his ICD.

We have two opinions of this subject. One from our US group of experts, who say he should be allowed to play until the disease becomes apparent (seen on echo or MRI), and another opinion from the European group of experts who are more conservative on this issue, and say that play should not be allowed. As he is likely to show signs/symptoms of the disease at some point, I’d let him play now, before he unequivocally needs to be restricted. There is a nice paper from Circulation on genetic diseases in young people. It states that things like bowling, golf, swimming laps, brisk walking, and moderate biking are probably all allowable, even after phenotypic expression (appearance of the disease on echocardiogram or MRI).

Hi JoAnna! You probably already know this is somewhat rare and we are learning more about it in recent years. There is little information regarding how much activity, but I think we need to approach it like a right ventricular cardiomyopathy. In this case, I think the pediatric cardiologist is correct. Soccer would be a high dynamic sport, and probably way too much for this type of disease. You may wish to seek an opinion from those who have published on this subject. The T-ball may also be a bit too much. The Circulation article I mentioned above (in question 1) says brisk walking only. The other consideration is that you want him to get involved in activities that he can continue as he gets older, rather than taking away things he loves. So sports like golf provide that lifetime opportunity.

Please see my reply to Rick for more elaboration. But the cost of an ECG is $50-$75. I would call that “retail”. The cost can be decreased by getting volunteers to perform the ECG (provided they could implement a high quality test.) getting already paid employees such as school nurses to do the testing (a lot of work as each ECG takes 10 min to do, and physicians are still needed to interpret) renting the ECG machine, and paying for paper (about $1 per student/athlete/patient), I’ve done screenings using this approach and the cost can come down to about $10 per test. However, given a school of 3000 student, screening of the entire student body could cost up to $30,000. The reason HPV vaccine may be required is that studies have shown it to be very effective. To date, we do not have a well-controlled prospective study in the US showing the same for ECG screening. I hope this explains some of the apparent confusion in recommendations.

The NCAA as an institution does not endorse the routine use of ECGs and/or echocardiograms. Nonetheless, some of its member institutions have chosen to go this route, some for many years. The University of Wisconsin and Purdue are some of the ones that come to mind. I worked at Ohio State University and did oversight for the cardiac portion of the pre-season screening program. Our program consisted of the 12 element AHA history and physical, incorporated into the main pre-season evaluation. We did not do ECGs or echocardiograms in all the athletes, only those in whom a “red flag” was raised by the 12 element history and physical. We did not choose to do ECGs and ECHO because strictly from the view of evidence-based medicine, there are several unanswered questions regarding routine screening with ECG and/or echo.

One cannot say with certainty that adding the cardiac diagnostics adds something beyond the H and P alone. Most people point to the Italian study of cardiovascular screening and how there was a concomitant decline in the sudden cardiac death rate over a 20 year period after ECG was added to the screening program. However, this was not a randomized prospective study. Thus, not the best kind of study. Also the initial death rate before ECG screening was quite high, and after ECG was implemented is similar to what the US has experienced for many years. Thus, we cannot say we would see the same decline in the US if the issue was studied properly here. It’s tempting to extrapolate the Italian data to our population, but we are genetically different, and what applies in Italy may not apply here. In addition, although ECG and ECHO are “decent” tools to detect hypertrophic cardiomyopathy (HCM, number one cause of SCA in athletes) both tests are either inadequate at predicting or not so good at detecting number two and three causes of SCA in athletes (commotio cordis and anomalous coronary artery respectively). ECG detects 75% of asymptomatic HCM. Thus it is entirely possible to miss a substantial number of HCMs in those athletes without symptoms. Thus, those who undergo such screening may be left feeling overly certain that screened athlete has no heart disease when in reality, the athlete may still be at risk. I do not object to screening. However, it is important to know what to do with the information and to let the athlete and parent know screening is never 100% reliable (possibility of false negatives). Lastly, athletes can have false positives. This can be problematic, as approximately 10-40% of athletes may require further cardiac evaluation, causing delay in athlete returning to play.

Teens can have tough time not doing what their friends are doing. They may not be open to reading either. I think what helps is that all folks who care about the teen, like parents, coach, friends, physician, school nurse, and athletic trainer communicate with one another and provide the same message. If the teen hears it consistently from everyone that recommendations are being made for his/her own wellbeing, then the teen may be more likely to accept the recommendations. Also, while they may not be able to play aggressive basketball, or compete in swimming, they can certainly find something else to do like be team manager, or keep track of scores. This may help him/her feel included.

There seems to be pretty compelling evidence that AEDs are effective in responding to SCA in public places, including sporting events, health clubs, etc. How can a school district, youth sports league, etc. afford NOT to implement an AED program? It seems more and more like they are putting themselves at risk for failing to have a simple tool readily available to respond to SCA.