Dual testing for heart defects in young athletes recommended

Kathleen Blanchard's picture
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Young athletes can have serious heart defects that could lead to sudden death. A new study from Johns Hopkins recommends performing EKG and echocardiogram rather than just electrocardiogram (EKG) to increase the chances of finding hidden heart defects - a cause of 3,000 deaths a year in young adults that can occur from heart rhythm disturbance (sudden cardiac death).

The risk of sudden cardiac death is high in athletes who have inherited tendencies to develop enlarged hearts and thickening of the heart muscle. Several athletes have died during peak performance from hidden heart defects.

Theodore Abraham, M.D., an associate professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute, screening young athletes for heart defects, "has to be comprehensive. 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." Dr. Abraham leads the "Heart Hype" screening program run by Johns Hopkins.

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Researchers looked at 134 top athletes from high schools in Maryland, checking for heart abnormalities. They conducted thorough physical exams and performed ultrasound of the heart (echocardiogram) and to look for hypertrophic cardiomyopathies (enlarged hearts) and heart valve abnormalities, and EKG to measure electrical signals in the heart.

Abnormalities were found in 36 of the 134 young athletes, but none had life threatening heart defects. Twenty-two cardiac abnormalities were found on EKG, nine were discovered using echocardiogram alone, and five were picked up on both tests. High blood pressure and elevated blood pressure was discovered in 29 and 19 of the athletes respectively, requiring physician follow-up.

One in five hundred Americans has undiagnosed cardiomyopathy, making the findings no surprise. However, the authors say the study is important to raise awareness about health risks in young athletes, not just sudden cardiac death. This year’s screening program found two athletes with serious and asymptomatic problems – one may require heart transplant from an unknown existing problem, and the other had undiagnosed heart valve disease.

For opponents of screening carefully for heart disease in young athletes, that costs more, Abraham says, "What is the price for a single life?" We're counting the costs upfront. We're not counting the savings on the downstream end." He also says it’s important for athletes to report symptoms of fainting, shortness of breath, or chest pain with activity. The authors say EKG testing alone will miss heart defects in young athletes. Screening should be combined with echocardiogram.

Johns Hopkins Heart & Vascular Institute

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