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    Should We Screen for Heart Disease Before Athletics?
      Posted on Sunday, July 24 @ 11:54:35 EDT by admin  
      Health SOURCE
    Everyday Health By T. Jared Bunch, MD Published Sep 30, 2014

    Sudden deaths among young people who complete in athletics are terrible and tragic events. In the October 2014 issue of the journal JACC, many of the world experts in this area released a consensus statement to provide guidelines on when to screen for heart disease, in order to avoid this tragedy.

    Fortunately, such events are rare. However, they are devastating and are often covered broadly in the news. Unfortunately, sudden death can occur at any time and often without warning even after years of athletic participation. As a parent of children participating in sports, these news reports occur too often and touch me on a personal level. I suspect they do most who read them.

    I have had the pleasure of knowing Danny Berger. Danny came from a family of parents and siblings who all played college athletics. He grew up as an exceptional athlete and excelled at basketball. At over six feet six inches tall, he was highly recruited to play college basketball. He played at the collegiate level for two years and improved yearly in all phases of the game. He entered his junior year with anticipation to contribute significantly to a Utah State University (USU) basketball team that perennially wins over 20 games a year.

    Then the unspeakable happened.......

    ...An Unexpected, Sudden Collapse

    The USU basketball team was going through a walk-through practice before departing to play Brigham Young University that evening. During this walk-through practice session Danny suddenly collapsed. The USU trainer Mike Williams was prepared and had trained the staff for such an event. An automated external defibrillator (AED) was immediately available courtside. The AED patches were placed on his chest and back within seconds. The AED immediately delivered a life-saving shock and restored Danny’s heart rhythm to normal. He recovered completely and resumed playing basketball from USU.

    Danny has become a tremendous advocate for AEDs being available in all schools and athletic events. He was recognized for his outstanding service last year at the NCAA final four basketball tournament as part of an all-service team.

    Danny had played at a very high level in basketball throughout his life. There were never any warning sings before the eventful day when the cardiac arrest occurred. Danny was fortunate; USU was prepared and delivered the necessary lifesaving AED therapy without delay or hesitation.

    When Screening Is Essential

    As parents or those who coach and teach young athletes, we face an important question. When should a person receive heart screening before they participate?

    World experts released a consensus statement to provide guidelines. It would be nice to screen all kids in the United States with a basic cardiac test such as an electrocardiogram. This seems reasonable, until the scope of need is realized. In the United States this would include screening about 60 million young participants, including about 10 million competitive athletes. Unfortunately, for now, there is no nationwide screening program or approach. We need to rely on identifying people at risk based upon signs, symptoms, and their family history.

    What are the signs and symptoms listed by the newly released guidelines that suggest the need for additional screening before active participation?

    4 Symptoms That Mean Cardiac Screening Is Needed

    1:Chest pain/discomfort/tightness/pressure related to exertion
    2:Unexplained passing out or near passing out
    3:Shortness of breath or heart palpitations that seem out of proportion to the level of exercise performed
    4:I would add personally, a prior seizure experienced with physical activity of any kind

    4 Signs From a Prior Medical Exam

    1: Heart murmur
    2: Elevated systemic blood pressure
    3: Prior restriction from participation in sports
    4; Prior testing for the heart of any kind, ordered by a physician

    4 Concerning Family History Events

    1: Premature death (sudden and unexpected, or otherwise) before the age of 50 years suspicious to be related to heart disease in 1 or more relatives
    2: Disability from heart disease in close relative less than 50 years of age
    3: Hypertrophic or dilated cardiomyopathy, long-QT syndrome, or other ion channelopathies, Marfan syndrome, or clinically significant arrhythmias; or any other sudden death syndrome
    4: I would add, personally, a family history of drowning

    In my opinion, if you are unsure if your child has experienced these symptoms or if you are unclear about the significance of your family history, it is better to discuss this with your physician before your child starts to participate in high-level to elite-level athletic competition.

    Having an AED Onsite Saves Lives

    However, as a parent, coach, principle, or youth sports leader another part of Danny’s story remains very relevant and important.

    Danny is alive today because USU had an AED immediately available. It is not excusable, in my opinion, for any school to not have an AED. It is not excusable for these schools not to have a program to make sure the AED is functional, supplied, and the battery is active, and their staff is trained to use the device. It is not excusable to not have an AED immediately available for sporting events that occur under their supervision or on their property. I mention “school” broadly; consider this same approach to safe guard these young participants that are involved on club teams, traveling teams, all-star teams, etc.

    With cardiac arrest, mortality goes up by 10 percent for each minute that passes. If it takes three to four minutes to get an AED and then another minute to connect it to the person, many lives will be lost unnecessarily. Before you allow your child to participate in any sport, make sure that these conditions with an AED and training are met. As a parent or coach, make sure you know where the AED is located.

    Fortunately, youth deaths during sports are relatively rare. The death rate from sports trails behind deaths from motor vehicle accidents, suicides, cancers, infections, and accidental firearm discharges. Fortunately, many of the sports-related cardiac deaths are preventable if at risk participants are first screened and AEDs are immediately available at all the events. Screening is not enough. Danny’s heart screening would have been normal. An AED still needs to be available even if the participants all seem healthy, have competed before, and don’t have high-risk signs or symptoms.

    I do wish to make a plea to parents and community leaders, that you contact the principles in your area and make sure that all schools from elementary to high school have an AED available. If they do not, find ways to help supply these life saving devices to our schools through local advocacy and sponsorship.

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