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Preventing Cardiac Problems in Young Athletes

May 20, 2010 11:59 AM with Dr Jason Robin

Join Dr. Jason Robin as he discusses sudden cardiac death in athletes and how parents can get their children screened prior to participating in athletics. Board certified in Cardiovascular Disease and Nuclear Cardiology, Dr. Robin specializes in preventive care.

Moderator (Moderator) - 11:58 AM:
Welcome! Today’s chat: Preventing Cardiac Problems in Young Athletes will begin shortly. Please start submitting your questions and Dr. Jason Robin will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit our Cardiovascular Care Pages to obtain more information.

Dr Jason Robin (NorthShore) - 12:06 PM:
Hello. My name is Dr. Jason Robin and I am a board certified cardiologist in private practice in Glenview and Evanston (CAGE). I look forward to the questions you may have today.

  Elaine (Evanston, IL) - 12:07 PM:
How well can the general pediatrician diagnose underlying heart disease?
Dr Jason Robin (NorthShore)
Great question. The pediatrician obviously is involved with the pre-participation screening process for high school athletes. Recent data suggests that the routine history check and physical may not be adequate in ruling out dangerous cardiac conditions. The addition of an ECG increase the ability to detect cardiac problems two-fold and most pediatricians don't do ECGs in the office. This is how athletes who are Olympians and athletes in Europe have been screened for decades.

  Noelle (Willowbrook, IL) - 12:10 PM:
What kind of precautions should I take on my children before they go out for practice or games?
Dr Jason Robin (NorthShore)
In general, if your child is healthy and has no known cardiac or pulmonary disease, there is a very, very, very low risk of complications from exercise. The annual rate of sudden death in "young healthy" athletes is ~1/100,000 per year. So, my advice would be to keep them hydrated and avoid exposure to excessive heat.

  Suzie (Wilmette) - 12:13 PM:
I have a 10 year old athlete with asthma who has experience chest discomfort and shortness of breath with exercise (this is new - usually well controlled). Adjusting asthma meds, but wondering if at some point a cardiac evaluation would be warranted?
Dr Jason Robin (NorthShore)
This very well could be related to the asthma. I would say that if the symptoms do not improve via modifying inhalers, it would be reasonable to get an echocardiogram to rule out any significant structural heart disease. This is a non invasive test (essentially an Ultrasound) that could be done in the office in 30 minutes. There are no side effects, or radiation etc.

  Frank Costanza (Glenview, Illinois) - 12:16 PM:
Why can't the pediatrician find these problems when the kids go in for their check ups?
Dr Jason Robin (NorthShore)
Great question Frank. The most common cause of sudden death in the athlete in this country is hypertrophic cardiomyopathy (Hank Gathers, Reggie Lewis and others). It is seen in 1/500 people. Unfortunately, this will not get picked up on the physical exam in over half of these patients and often it is not illicited in the history by the athlete of the parent. Unfortunately, the first symptom can actually be sudden death. Thus, more sensitive screening is needed to be complete with the evaluation and this can by an EKG or an echocardiogram. Often, an EKG is sufficient, but the problem is that up to half of all teenagers have false positive EKGs (it will be read as abnormal but there is actually no structural heart disease). A follow up echocardiogram reassures the athlete that the heart is normal. If there truly is an abnormality, the echocardiogram is almost certain to pick it up and establish the diagnosis.

  Jamie (Glenview,IL) - 12:23 PM:
I have a son with heart disease, should his brothers and sisters also be evaluated?
Dr Jason Robin (NorthShore)
Jamie, great question. It depends what the heart disease is. Many are not hereditary. However, if your son has something like hypertrophic cardiomyopathy, the most common reason for sudden death in young people, YES, they should be screened as this is autosomal dominant. This means there would be on average a 50% chance each child having the disease.

  Noelle (Willowbrook, IL) - 12:26 PM:
Why is sudden cardiac arrest so difficult to predict?
Dr Jason Robin (NorthShore)
Noelle, cardiac arrest in young people is difficult to predict because the screening guidelines at this time are not very good at picking up many of the potentially fatal conditions which can be related to muscle problems of the heart or electrical problems of the heart. Since the overall incidence of sudden death in a young athlete is low (1/100,00 per year), there has not been a strong push to change the current guidelines from the American Heart Association. This may change in the upcoming years.

  Suzie (Wilmette) - 12:31 PM:
At what age would you recommend EKG as a screening tool and in general, do you know if insurance covers it for screening purposes? If not, what is the expected cost?
Dr Jason Robin (NorthShore)
Suzie, excellent questions. 1) Age: I would say that before an adolescent participates in high intensity competition, there is good data that supports an EKG prior to participating. 15 years of age seems reasonable as this is around the time that some of the more common cardiomyopathies start to manifest. 2) Insurance: Depends on what insurance plan you have. If there is a diagnosis such as "syncope," "Chest pain," "palpitations," etc, it likely will be at least partially covered. 3) The expected out of pocket cost could range from $50 to $200

  Todd Heyden (Chicago, IL) - 12:36 PM:
"The conditions that cause sudden cardiac arrest usaully do not show up during a phsyical or an athletic screening." (TIME Magazine, 5/7/07). Question 1: Is this accurate? It seems the way to solve this epidemic is to pass a federal law requiring all states have an AED readily avialable. Question 2: If this law was passed and all high school athletes were screened, could this be done in a cost effective way with results significantly impacting the amount of deaths to young athletes?
Dr Jason Robin (NorthShore)
Todd, great point and questions. 1) yes, the routine screening which a high school athlete gets will indeed miss over half of the potential diagnoses that can be associated with sudden death. Recent literature from the Annals of Internal Medicine reported that the likelihood of picking up these diseases through current screening (ie history and physical exam) is ~40%. 2) The AED is a good idea, and certainly in airports, this has been shown to be effective in aborting sudden cardiac death. As far as cost effectiveness goes, the AED costs nearly $200,000 per year to save 1 life while an EKG costs <$50,000 per year to save a life. So, I would say that screening with an EKG gets you better bang for your buck. Unfortunately, the false positive rate is very high (~50%). That is why our group has initiated a program with local high schools and colleges to perform a screening EKG AND echocardiogram at a "cost effective price," thus quickly eliminating the worry from the false +s.

Moderator (Moderator) - 12:49 PM:
Thank you everyone for your great participation, the chat will be ending in approximately 10 minutes. Please submit any final questions you have.

  Noelle (Willowbrook, IL) - 12:50 PM:
Are there physical and athletic screenings that can predict sudden cardiac arrest?
Dr Jason Robin (NorthShore)
The best and most reasonable way is for a physician who has adequate training in the pre-participation screening process to perform a very thorough history (with the parent present) and physical exam. In my opinion, this should be supplemented with an EKG and if necessary, an echocardiogram (if the history, exam, or EKG is concerning). This is a more comprehensive screening model and is much less likely to miss a diagnosis which can lead to problems in the setting of intense physical activity. If there is significant pathology, this may need to be followed up with more testing and rarely, we would advise that the athlete not participate.

  Suzie (Wilmette) - 12:55 PM:
Does an asymptomatic arrhythmia (PVCs, trigeminy) in a parent increase the risk for their children?
Dr Jason Robin (NorthShore)
Probably not, but very good question. Most PVCs are benign and PVCs are not hereditary. However, if there is an underlying cardiac condition (muscle or serious electrical problem) which you have, this can be passed on. If your heart has been evaluated with an echocardiogram, Holter monitor and perhaps a stress test and the results were benign, there is probably nothing to worry about for you or your children.

Dr Jason Robin (NorthShore) - 1:03 PM:
Wow, time flies when you're having fun. Great questions today. I hope that I was able to answer them sufficiently. If you have more questions, would like to know more about our young athlete screening program, or would like to come in for a cardiovascular assessment, we would be delighted to meet you. http://www.cagemedical Thank you. Jason Robin, MD Assistant Professor of Medicine The University of Chicago Pritzker School of Medicine Cardiovascular Associates of Glenbrook and Evanston, LLC 847 869 1499

Moderator (Moderator) - 1:04 PM:
Thank you again for participating in our chat today. For more information please visit our Cardiovascular Care Pages


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