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Dual Heart Tests Best for Young Athletes

When Screening for Heart Defects, 2 Tests Better Than 1

By Charlene Laino
WebMD Health News

Reviewed By Louise Chang, MD

Nov. 18, 2009 (Orlando) -- Young athletes should be screened with two common heart tests, not just one -- or early signs of life-threatening heart defects may be missed, researchers report.

"The chance of finding an abnormality is rare, but if it is missed, the consequences are catastrophic," says Theodore Abraham, MD, an associate professor at the Johns Hopkins University School of Medicine's Heart and Vascular Institute.

The two heart tests are an echocardiogram, or ECHO, which measures heart size and pumping function and checks for faulty heart valves, and an electrocardiogram, or EKG, which assesses the heart's electrical rhythms.

Each year in the U.S., more than 3,000 people aged 15 to 34 succumb to sudden cardiac death as a result of heart rhythm disturbances, Abraham says.

Athletes who have inherited tendencies to develop overly enlarged and thickened hearts are particularly at risk, he says.

Many fall victim with little or no warning. Fans often express shock when star athletes, like Reggie Lewis of the Boston Celtics, collapse and die despite seemingly being in peak physical form, he says.

"Studies have shown that screening all athletes is not cost-effective, so we wanted to see if there was a way we could refine the screening process," Abraham tells WebMD.

Dual Heart Tests Pick Up More Problems

The new study, presented at the annual meeting of the American Heart Association, involved 134 Maryland high school athletes participating in the 2008 track and field state championships.

The researchers were looking for life-threatening cardiac abnormalities such as hypertrophic cardiomyopathy, a condition in which the heart muscle thickens abnormally and whose patients often have no symptoms.

"We did a very focused exam. First, we took a 10-minute medical history, then we took weight and blood pressure measurements. Using a stethoscope, we listened for unusual heartbeats or murmurs. Then, we conducted an echocardiogram and an EKG," Abraham says.

None of the student athletes was found to have life-threatening heart defects, but 36 exhibited abnormal findings on ECHO or EKG. Twenty-two abnormalities were detected by EKG alone, nine by ECHO alone, and five were picked up on both tests.

"If we had only done the ECHO or the EKG, a significant number of abnormalities would have been missed," Abraham says.

"If you are going to screen, it 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."

Aurelio Pinheiro, MD, a postdoctoral research fellow at Johns Hopkins who also worked on the study, wasn't surprised that none of the athletes had a life-threatening heart abnormality as so few patients were screened.

"But with larger numbers, life-threatening conditions would be missed," Abraham says.

Athletes with abnormalities -- which included 19 with high blood pressure, 29 with slightly elevated blood pressure, and five with low blood pressure readings -- were referred to their doctors for follow-up.

In some nations, including Italy, federal law mandates screening of young athletes, he says. "That's probably not going to happen here, but we do need better programs," he says.

In the meantime, Abraham urges any athlete with abnormal symptoms, no matter how trivial they seem, to consult their coach or doctor.

"Let someone know how you are feeling, especially if you have had chest pains, shortness of breath, or have fainted." he says. "This could save your life."

Michael Sayre, MD, associate professor of emergency medicine at Ohio State University in Columbus, agrees that screening of athletes is important.

But he tells WebMD that he also worries that too much testing could have negative consequences.

"One in four athletes in the study had abnormal test results, but none had significant problems. There's a risk the tests could identify people who don't have problems. They may worry unnecessarily or choose not to participate in sports when they shouldn't," he says.

SOURCES:American Heart Association Scientific Sessions 2009, Orlando, Nov. 15-19, 2009.

Theodore Abraham, MD, associate professor, Johns Hopkins University School of Medicine's Heart and Vascular Institute.

Aurelio Pinheiro, MD, Johns Hopkins.

Michael Sayre, MD, associate professor, emergency medicine, Ohio State University, Columbus.

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