University Hospital of Brooklyn at
Long Island College Hospital
Furqan H. Tejani, MD
Director, Advanced Cardiovascular Imaging
The Downstate Diagnosis Archive
The Downstate Diagnosis:
The Heart of a Student Athlete
The most heartbreaking scenario of all for parents: with no warning at all, an otherwise healthy student athlete suddenly collapses and dies while playing a sport. You've noticed your child sweats a good deal, is dizzy at times and struggles to catch his or her breath – is that normal for someone playing a competitive sport, or are those symptoms that should have you running to the doctor? Should all students be screened for heart disease before being permitted to join a team at school or with a club? This is a case where the experts do not agree.
What can cause heart disease in young people?
- A condition present at birth called hypertrophic cardiomyopathy (HCM) causes 40% of all cardiac arrests in young people. HCM is a thickening of the heart muscle. This causes the heart to work harder and harder to pump blood.
- High cholesterol, which is associated with heart disease, nowadays affects up to 15% of children and adolescents – a much larger number than in the past.
What are the different types of heart exams?
- Chest x-rays – an ex-ray will tell you if the heart is enlarged
- Electrocardiogram (ECG) – this checks the heart rhythm to see if it is beating properly
- Echocardiogram - this is a 3-D ultrasound of the heart's structure
What are the arguments for routine screening of student athletes?
- Heart disease in the young and seemingly healthy happens more than we think. The American Academy of Pediatrics now estimates that 2,000 kids under 25 die from heart disease each year in the USA.
- Kids who play competitive sports are at even greater risk than sedentary kids – the exact opposite of what we'd expect
- EKGs only cost around $150 and many insurers will cover the cost. Not a high price to pay for peace of mind
- As with many medical tests, a certain percentage delivers results that are called false positive. That means an abnormal result was suggested. To make sure, we then need to order even more tests, some of which may be costly and invasive.
- A screening can only provide information. It cannot stop a student athlete from participating in the sport.
- The medical system will have to screen large numbers of kids to identify a relative few who are at risk.
What do I think? I believe that student athletes participating in high-intensity sports such as football, basketball, squash or soccer would benefit from a complete physical and an EKG. The physical includes family history, personal history, blood pressure, cholesterol testing and so on. The truth is we do not see an overwhelming number of adolescents and college kids whose ECG shows abnormalities. But when we do, they are usually profound, and we are grateful that we had the opportunity to save a young person's life.
Read the story of Javier Bosque, a student athlete who collapsed in a nearby park. We treated Javier and his story has a happy ending.