Which heart screenings are necessary for athletes?

Every parent wants to keep his or her child safe. For many parents of athletes, it's not just sprains and strains that cause anxiety; it's the possibility of an undiscovered heart condition.

In an effort to uncover a heart problem and prevent sudden death in an athlete, some organizations are advocating for all student athletes to undergo electrocardiograms (EKGs, also referred to as ECGs). EKGs monitor the electrical signals that control how the heart beats and pumps blood.

These non-invasive tests may detect an unrecognized heart condition, but there are many heart problems an EKG cannot detect. In fact, some athletes may receive a false positive test result, leading to additional expensive and unnecessary testing.

William Scott, M.D., Pediatric Cardiac Electrophysiologist at Children's Health℠, and Associate Vice Chairman for Multidisciplinary Programs and Professor of Pediatrics at UT Southwestern, explains the limitations of heart screenings and how to keep young athletes safe.

Know family history and warning signs

Athletes are screened for heart problems every year.

"In Texas, there is a minimum requirement of a 10-point questionnaire and a physical examination to participate in high school sports," says Dr. Scott. "The questions, developed by the American Heart Association, specifically look for information that might indicate a heart problem." A large part of this questionnaire covers family and the athlete's medical history. In order to evaluate the risk of sudden cardiac death, the questionnaire includes a short physical exam and asks:

• Has your child ever fainted during exertion?
• Has your child ever experienced chest pain during exertion?
• Has anyone in the family ever died of sudden cardiac failure?
• Other questions about your child's personal and family history

A yes answer to these questions does not automatically mean the athlete has a heart condition. However, it may indicate a need for further evaluation. If there are concerns, the athlete should be seen by a pediatric cardiologist. "Once one of those red flags is raised, a comprehensive review is warranted," says Dr. Scott. "It's very likely an electrocardiogram will be part of the evaluation when there is any suspicion of a heart problem."

If an athlete is healthy, has no worrisome symptoms and does not have a family history of heart disease, they and their family should not be concerned about a hidden heart condition. The athlete likely doesn't need an EKG. Instead, athletes, parents and coaches should keep an eye out for warning signs including:

• Chest pain
• Dizziness
• Fainting
• Heart palpitations
• Unusual shortness of breath
• Unusual fatigue
• Weakness

If any of these signs are present, it's important to talk with the athlete's primary care physician, who can make a referral to a subspecialist.

Understand the risks and benefits of an EKG screening

While an EKG may detect an undiagnosed heart problem, it may also miss many heart conditions such as inherited irregular heartbeats, certain types of cardiomyopathy or abnormalities in the coronary arteries. These problems can cause sudden cardiac death. EKGs can also have false positive readings.

"False positives can cause a great deal of anxiety and expense," says Dr. Scott. "That's one of the disadvantages of an electrocardiogram test – it doesn't always identify a problem, and the screening may suggest a problem that really doesn't exist. That's one of the reasons we don't recommend EKG screenings for every child."

False positives can keep an athlete out of a sport until they can get further testing from a pediatric cardiologist. "Some families may not have the economic means to pay for screenings and find themselves under duress to find a way to get their athlete evaluated," says Dr. Scott. "It can put kids in a real bind."

Though Dr. Scott doesn't recommend mandating every athlete have an EKG before participating in a sport, he believes any family or athlete wanting an EKG should be able to get one. "If a parent is concerned and talks to their pediatrician about screening their teen with an EKG, then we will provide the EKG."

Sudden cardiac death in athletes is rare

Because the media covers almost every athlete death, it can be hard to remember how rare these conditions truly are. "In the Dallas-Fort Worth area, there are a couple hundred thousand athletes and these tragedies occur approximately half a dozen times a year," says Dr. Scott. "The risk of it happening has been estimated at 1 in 50,000, but when it occurs, we see it on the news, and the personal risk feels much higher."

Most importantly, athletes, parents, coaches and school officials should be prepared for an emergency. "All athletic events should have several adults trained in CPR and an AED immediately available," says Dr. Scott. Non-athletes can also experience sudden cardiac death from the same types of conditions. Dr. Scott suggests:

• Each school have an emergency preparedness plan that they rehearse at least once a year.
• All parents and coaches know CPR and how to use an AED.
• An AED should be within a one- or two-minute walk of all events with athletes.

"No matter how many screenings are performed, not all conditions can be identified 100 percent of the time," says Dr. Scott. "We can't know everybody at risk, so we need to be prepared for anybody." When a sudden cardiac event occurs, overall awareness, proper preparation and quick response are key to saving a life.

Learn more

The nationally renowned team of pediatric cardiologists and subspecialists at Children's Health treat the whole spectrum of pediatric heart problems, with a commitment to excellence. Learn more about our programs and treatments.