Transcript of Cardiac screening high school athletes
- 1. Cardiac Screening in High School Athletes
SportsMedicinePodcast.com
- 2. DISCLOSURES No relevant financial relationships Meets
California AB1195 requirements for Cultural And Linguistic
Compentency
- 3. Agenda Why talk about cardiac screening in high school
athletes? How common is sudden cardiac death? What can (and should)
we change ? How effective is our current cardiac screening? How do
we screen currently?
- 4. Why talk about cardiac screening?
- 5. Why talk about cardiac screening?
- 6. Why talk about cardiac screening?
- 7. 39 | 2011 Kaiser Foundation Health Plan, Inc. For internal
use only.June 12, 2013 Why talk about cardiac screening?
- 8. Why talk about cardiac screening?
- 9. How common is SCD?
- 10. How common is SCD? Organized High School/College Athletes
Males - 1:133,333 per year or 7.5 per million Females -1:769,230
per year or 1.3 deaths per million
- 11. How common is SCD? Military Boot Camp 13 deaths per 100,000
recruit-year thats about 120 deaths over 25 years
- 12. How common is SCD? Marathon Runners 1:50,000 Race Finishers
(Mean Age 37yo) Marion 1986 1:184,000 cardiac event/ runners
(Baggish 2012) Triathlons 1:75,000 deaths/ triathletes
- 13. How common is SCD? Total Deaths per year from SCD in
athletes? about 300
- 14. How common is SCD? Ryan Shay Hank Gathers Fabrice
Muamba
- 15. How common is SCD? Rich Peverley Dallas Stars
- 16. Causes of SCD?
- 17. Causes of SCD? HCM 36% Coronary Anomalies 17% Increased
Cardiac Mass (possible HCM) 10% Ruptured Aorta/Dissect 5% Tunneled
LAD 5% Aortic Stenosis 5% Myocarditis 3% Dilated CM 3% Idiopathic
Myocdardial scarring 3% Arrhythmogenic RV dysplasia 3%
- 18. Current Recommendations
- 19. 2007 - AHA and Six Sports Medicine Organizations Current
Recommendations - U.S. 12 Point Cardiac Screening added to PPE
Personal Medical History Family History Physical Exam
- 20. 2007 - AHA and Six Sports Medicine Organizations Current
Recommendations - U.S. Personal Medical History - Exertional chest
pain or discomfort - Unexplained syncope/near-syncope - Excessive
exertional fatigue/dyspnea - Prior diagnosis of heart murmur -
Elevated blood pressure
- 21. 2007 - AHA and Six Sports Medicine Organizations Current
Recommendations - U.S. Family History - Premature sudden death
(< age 50) - Disability from heart disease (< age 50) -
History of HCM, LQTS, Marfan Syndrome
- 22. 2007 - AHA and Six Sports Medicine Organizations Current
Recommendations - U.S. Physical Exam - Heart murmur - Femoral
pulses (aortic coartation) - Marfan-like appearance - Brachial
artery blood pressure
- 23. Effectiveness
- 24. Overall AHA Compliance Score 0-4 5-8 9-11 12 PEDIATRICS
0.8% 11.2% 83.0% 5.3% FAMILY MEDICINE 0.5% 13.3% 80% 5% TOTAL 0.7%
12.2% 81.4% 5.7% Source: Madsen NL, et al, Br J Sports Med 2013;
47:172-177
- 25. 41 AHA vs EKG Positive Results Needed W/U H&P EKG Total
Wilson - UK 2720 athletes 2.5% 1.5% 4% Bessem Netherlands 428
athletes 8% 8% 13% Hevia Spain 1220 athletes 1.2% 6.1% 7.4% Baggish
US 510 athletes 6% 16% 20% Total 4878 athletes 4.4% 7.9% 11.1%
Source: Asif IM, Drezner JA, Prg in Cardio Disease, 54 (2012)
445-450
- 26. Why not an EKG on every athlete?
- 27. To EKG or Not? Europe requires a resting EKG Italy (Venuto)
1982 - SCD 4.2/ 100,000 athletes 2004 - SCD 0.9/ 100,000 athletes
Most common cause in Italy? Arrhythmogenic RV dysplasia.
- 28. Whats a normal EKG? EKG Findings in Athletes considered WNL
Sinus Bradycardia as low as 30-40 bpm Various A/V blocks occur in
up to 33% of athletes First Degree (PR>0.2) Most Common Second
Degree (Mobitz-1 or Wenkeback) Increased R or S wave voltage
without Left axis deviation, QRS prolongation, or LAE Incomplete
RBBB U-waves with up-sloping ST segments and normal T waves
- 29. Causes of SCD Hypertrophic
Cardiomyopathy********************** Sporatic or inherited
(autosomal-dominant) Can predispose to malignant ventricular
arrhythmias leading to syncope or sudden death S/S: Dyspnea
(initially exertional in onset), Angina, Exertional syncope,
exertional presyncope, fatigue, palpitations Exam: Systolic murmur
that increases with valsalva Testing: CXR: cardiomegaly EKG: LVH
Echo: confirmation of HCM Tx: B-Blockers ICD Septal artery ethanol
ablation
- 30. Causes of SCD Coronary Artery Anomalies In one review of 78
cases of CAA who died of sudden death, 62% of those were
asymptomatic S/S: Only ~ 1/3 of pts have any symptoms of exertional
syncope (