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Wednesday, August 12, 2009

Sports Physicals - Assessing for Cardiac Disease and Malformations:

With summer coming to an end, student athletes are preparing for fall sports and this often begins with the required pre-participation physical. Although this may seem like an unnecessary burden as you rush your child to the pediatrician before practice starts, it is in fact a very important visit.

One of the many things assessed during this visit is cardiac health in general, and more specifically, if a potentially undiagnosed heart problem could exist. Whether an EKG should be part of routine pre-participation physicals is debatable.

The current recommendation in this country is that it should not. The argument being that a thorough history and physical exam are as effective at uncovering potentially life threatening cardiac disease and malformations as an EKG. However, other countries disagree and routinely screen all athletes with an EKG prior to participation in organized sports.

What is not debatable is that a thorough history should be done and that further evaluation including an EKG or ECHO (echocardiogram) is necessary if any of the following questions are positive. Unfortunately, these exams are often rushed, or in an attempt to accommodate the patient, the forms are filled out using information from a previous yearly physical and these questions are never explicitly asked. The following is a list of questions that your child's pediatrician should ask prior to signing off on their pre-participation forms.

Have you ever passed out or nearly passed out during or after exercise?

Have you ever had discomfort, pain, or pressure in your chest during exercise?

Does your heart race or skip beats during exercise?

Has a doctor ever told you that you have high blood pressure, high cholesterol, a heart murmur, or a heart infection?

Has a doctor ever ordered a test for your heart (e.g., electrocardiography, echocardiography)?

Has anyone in your family died for no apparent reason?

Does anyone in your family have a heart problem?

Has anyone in your family died of heart problems or of sudden death before 50 years of age?

Does anyone in your family have Marfan syndrome?

Answering yes to one or more of the above questions does not necessarily mean that organized sports should be avoided but it does indicate a need for further evaluation and testing. If your child's answer is yes to any of the above questions, be sure to bring this to the attention of your child's pediatrician during the visit or when dropping off the forms.