Back to School for High School Athletes: What to Know from a Sports Cardiologist

As summer comes to a close and students go back to school, many parents and teens are gearing up for the Fall sports season. In the last few years, we have seen high profile episodes of sudden cardiac arrest in young athletes, notably Damar Hamlin, Cristian Erikson, and Bronny James.

Many parents have the same thought, “Is my child at risk?”.

Sudden cardiac arrest (SCA), a medical emergency which occurs when the heart stops beating, remains the leading cause of medical death among young athletes. However, the incidence of these events remains exceedingly low.

Common Causes of Sudden Cardiac Arrest:

Common causes of sudden cardiac arrest in young athletes are:

• Hypertrophic Cardiomyopathy (An abnormal thickness of the heart)
• Anomalous Coronary Arteries (The arteries of the heart coming from the wrong direction)
• Myocarditis (Inflammation of the heart muscle)
• Genetic Arrhythmias (Abnormal genetic heart rhythms)
• Commotio Cordis (Heart failure from chest impact)
  

Pre-Participation Physical Exam:

As a sports cardiologist, our goal is to mitigate the risk of athletes with pre-participation screening. A pre-participation physical exam (PPE) is generally required universally in order to participate in sport. However, the specifics of what is included in the PPE varies between school districts and individual states.

A PPE will generally include a standard medical history and physical exam. The goal of obtaining a medical history and physical exam is to identify potential life-threatening symptoms (chest pain, excessive shortness of breath, fainting spells) which may predispose some to sudden cardiac arrest. We will also take a detailed family history to understand risks that may have been passed down genetically.

Preventative Screening:

Sports cardiologists have adopted a well-established international ECG screening criteria for athletes, which can aid in determining who may need further cardiac testing. If the ECG is abnormal, the cardiologist may restrict the athlete from play to wait for other tests such as an echocardiogram (ultrasound of the heart) or an MRI of the heart.

An ECG can detect various heart problems, such as abnormal heart rhythms (arrhythmias), heart attacks, reduced blood flow to the heart (ischemia), structural issues like thickened heart muscle, electrolyte imbalances, and other conditions that affect the heart's function.

There is consensus in the sports cardiology community that ECG screening of young athletes, when interpreted by those with expertise in that age category, may be beneficial long term.  However, there may be challenges:

• Primarily, ECGs on all 8 million high school athletes may cause an unnecessary burden on the healthcare system when only a very small percentage will show an abnormality.
• Secondly, ECG screening by cardiologists without experience with athletic ECG changes may lead to a significant amount of false positives and athletic disqualification.
  

Emergency Action Planning:

One of the most important steps we can take as a community is to ensure our children are safe by having the tools and skills to respond in case of an emergency. Emergency Action planning (EAP) remains the focus of high school athletics, and it is imperative that every athletic department have an EAP.

EAP consists of the ability for coaches, athletic trainers, and teammates to perform cardiopulmonary resuscitation (CPR) and the availability of an Automated External Defibrillator (AED). In the event of an athlete having sudden cardiac arrest, it is essential to begin CPR and be comfortable using the AED. In the cases of Damar Hamlin, Cristian Erikson, and Bronny James, all athletes had immediate CPR and defibrillation. The quick response from trained individuals is what saved their lives.  

The combination of pre-participation screening and emergency action planning allows for a safe environment for high school athletes and parents to feel comfortable on the field.

To learn more about Dr. Arjun Kanwal, visit his bio page here.