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Case Grows for Screening Young Athletes...

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  • Lisa Salberg
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    Step one!
    I spoke to Kevin yesterday he said a much larger piece is set to run on Friday.

    Keep your eyes open!

    Lisa

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  • SharonBates
    started a topic Case Grows for Screening Young Athletes...

    Case Grows for Screening Young Athletes...

    Case Grows for Screening Young Athletes For Dangerous Heart Conditions

    Tuesday, June 21, 2005
    By: Kevin Helliker and Kathryn Kranhold
    THE WALL STREET JOURNAL

    ANTHONY BATES, a defensive tackle for Kansas State University, radiated a sense of health and fitness until the moment in 2000 when, following a light workout, he collapsed and died.

    An autopsy showed that the 20-year-old suffered from hypertrophic cardiomyopathy – a cardiac defect that makes vigorous physical activity dangerous but is treatable with lifestyle changes and other therapies.

    That condition would typically trigger alarms on an electrocardiogram, or EKG. This basic cardiac scan, which monitors the electrical activity of the heart, is administered routinely to people over 40, and is so inexpensive that the Medicare reimbursement for EKG is $25. But while many youth athletic programs in this country require a physical exam to participate, an EKG isn’t usually included.

    The knowledge that a common and inexpensive test could have saved the life her only child turned Anthony’s mother, Sharon Bates, into an advocate for routine cardiac screening of young athletes. An EKG, along with an ultrasound scan of the heart called an echocardiogram, can detect not only HCM but various other causes of sudden cardiac death in young athletes.

    Ms. Bates and other such advocates have received little attention from mainstream American medicine. But their cause is receiving support from the international cardiology community. In recent months, the International Olympic Committee issued a recommendation that young competitive athletes undergo EKG screening every two years. The committee said this guideline should be “used by as many countries as possible world-wide.”

    Following that recommendation, a group of cardiologists across Europe published a statement earlier this year in the European Heart Journal recommending routine screening of competitive athletes across the continent.

    Italy administers EKG screenings on all competitive athletes, and the research it has published on that program went along way toward convincing the IOC and cardiologists in other European countries that this practice saves lives. But the value isn’t necessarily limited to athletes. Japan administers EKG on all first graders and seventh graders, a program that it believes makes life-saving discoveries.

    Physicians sometimes compare an EKG to a thermometer, which can detect a fever but not its cause. When an EKG turns out positive, physicians then typically recommend that the patient receive a comprehensive echocardiogram. This may cost as much as $1,000, as opposed to as little as $50 for the limited echocardiograms offered at free-screening clinics.

    Most American cardiologists say this nation lacks the money and medical manpower to test every young athlete. While they agree that scans should be performed on athletes with a family history of sudden cardiac death or with symptoms such as heart murmurs, shortness of breath or a history of fainting, most say that sudden cardiac death in young athletes is too rare to justify widespread screening.

    Whether screening ought to be routine is a different question from whether individual parents ought to consider getting their children scanned. While neither EKGs nor echocardiograms can catch every defect, each of those scans can flag problems that a physician with a stethoscope would almost certainly miss.

    A statistic often cited is that only 10 to 13 cases of sudden cardiac death among young athletes are reported every year. But that figure is “profoundly understated and very misleading,” says Barry Maron, director of Hypertrophic Cardiomyopathy Center at Minneapolis Heart Institute Foundation. Though the government doesn’t track these deaths, a registry that Dr. Maron is compiling suggests that the annual toll could be as high as 200 to 300 young athletes, he says.

    Dr. Maron isn’t certain how any mandatory screening program could work. But he supports a voluntary screening movement that is gaining force across the nation. The largest player is California-based A Hear For Sports, which in recent years has conducted thousands of free-of-charge EKG and echocardiogram screenings of young athletes. The scans are read by board-certified cardiologists who donate their time.

    Michael Brodsky, a Southern California cardiologist who volunteered to read testes for a recent screening in Anaheim, says about 10% of the approximate 600 student athletes tested had some electrocardiographic abnormality, including two cases associated with Wolff-Parkinson-White syndrome, which can cause sudden fainting and in rare cases sudden death. A Heart For Sports officials say 10% is a typical finding in its community screenings.

    The scans aren’t ideal, EKG in particular can create false positives, requiring the patient to undergo further testing to rule out abnormalities. And there are potentially fatal conditions that they can miss, such as wrongly wired coronary arteries. Moreover, genetic conditions such as HCM can appear in early or late adolescence, which is why the IOC recommendation calls for repeating EKG screens every two years.

    But a growing number of American cardiologists believe if a screening program of some sort were implemented here, solutions to the limitations of scanning would be worked out. “Doing screening will forces us to address the limitations,” says Robert Myerburg, director of cardiology at the University of Miami School of Medicine.

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