Cardiac screening is crucial for athletes

Sudden cardiac death is always tragic. When it strikes highly trained athletes at the peak of their careers, further investigation must be carried out.

Locally, the 2007 death of Norwich Free Academy athlete Larry Pontbriant has resulted in legislation requiring the availability of automated external defibrillators (AEDs) at all high school athletic events in Connecticut. AEDs provide an electrical shock to the heart in order to correct a potentially fatal condition called arrhythmia.

Designing an effective cardiac screening program presents a challenge.

Ways to perform non-invasive assessments of the heart range from simply listening with a stethescope to highly technical imaging procedures. Some of those are:

• Auscultation — listening to heart sounds with a stethoscope. This is performed routinely as part of a pre-participation physical that should be required for all athletic activities at every level. Detection of a murmur or abnormal sound indicates the need for further evaluation.
• Electrocardiogram (ECG) — this examination provides an electrical map of cardiac function. It can detect a potentially fatal arrhythmia but provides only a snapshot while the athlete is relaxed.
• Cardiac Stress Test — evaluates the heart while the athlete is active, typically running on a treadmill.
• Echocardiography — allows visual examination of the heart’s chambers and valves through ultrasound.

The principle issue regarding the use of these examinations centers on cost.

At a recent American Heart Association meeting, one presentation addressed the ECG as a cost-effective way to screen student-athletes. The recent decline in the cost of laptop ECG machines allowed the authors to study every competitive sports athlete in a suburban high school for less than $3 each after an initial investment of $500 per school.

As technology progresses, sports medicine professionals must constantly re-evaluate the most efficient ways of screening athletes properly.