Ice Skating Health & Injuries
San Diego Figure Skating Communications
Sudden Death in Young Athletes
Undetected Heart Conditions in Young Athletes
The news reports of recent deaths of two high school athletes from heart conditions have caused parents to question their own kids' heart health and sports safety.
Can the same conditions that have resulted deaths on basketball courts and football fields produce a similar event in ice hockey, synchronized team skating, speed skating, and individual figure skating events - men, ladies, pairs, and ice dance?
The following articles can provide a basis for discussion with your child's coaches and athletic directors at schools, private sports associations, and operators of private and publicly owned and managed sports facilities such as ice rinks.
Defining what caused the unexpected death
The Minneapolis Heart Institute Foundation defines Sudden Death in Athletes as "an abrupt unexpected death of cardiovascular cause, in which the loss of consciousness occurs within 1 to 12 hours of onset of symptoms".
The majority of sudden deaths in athletes occur during or immediately after exercise (game, conditioning, training, etc.). However, some deaths occur at rest or during sleep. Autopsy is very useful in making a definitive diagnostic determination of the cause of sudden death. Certain conditions (i.e., Long QT Syndrome, Brugada Syndrome) require detailed post-mortem biochemical and sometimes genetic studies.
What is Sudden Death in Athletes?
It most commonly occurs in male athletes, who have estimated death rates nearly fivefold greater than the rates of female athletes. Congenital cardiovascular disease is the leading cause of nontraumatic sudden athletic death, with hypertrophic cardiomyopathy being the most common cause.
Screening athletes for disorders capable of provoking sudden death is a challenge because of the low prevalence of disease, and the cost and limitations of available screening tests. Current recommendations for cardiovascular screening call for a careful history and physical examination performed by a know- ledgeable health care provider. Specialized testing is recommended only in cases that warrant further evaluation.
Sudden death in any athlete is rare, but it is especially so in a young athlete. So what should sports organizations require at the start of each competitive season to screen its athletes? Schools require a physical, but obviously this is not a very detailed examination with the medical tests to evaluate for dormant or hidden physical defects/ abnormalities.
A fairly consistent theme has evolved in an examinations of clinical autopsy findings over the past 20 years: Sudden deaths in younger athletes were most frequently associated with congenital cardiovascular structural abnormalities.
Because the problem is estimated to occur at a rate of 1 in 2,000, there is cost consideration even if the testing is 99% accurate. A major concern is that "abnormalities" detected during examinations may merely be normal variants. The changes that occur in the heart in response to athletic training are known as "the athletic heart syndrome."
Health care screening of young athletes has focused on detection of hypertrophic cardiomyopathy. A good history and physical examination are accepted as the minimal standard for preparticipation assessment. Electrocardiography and treadmill stress testing experience a high degree of false-positive results (primarily because of athletic heart syndrome). As a result most research literature has focused on the use of echocardiography for diagnosis.
Source Everyday Health Related: What Should Schools Know About CPR?
Parents must watching for possible symptoms of heart problems and work closely with the directors of their child's athletic program(s) The following steps can protect your child from HCM and other causes of sudden cardiac deaths:1. Know the Warning Signs
Has your child ever fainted, complained of a racing heart, or had shortness of breath with exercise? Tell your pediatrician about it. “About 25 percent of children experience fainting at some point,” says Victoria Vetter, MD, pediatric cardiologist at the Children’s Hospital of Philadelphia. “Most of the time it’s because they're dehydrated or have low blood pressure, but it could be due to a heart condition.”
The same is true for other common symptoms of heart problems, shortness of breath and chest pain. “It could be asthma, but it also could be a heart condition,” she says. If your child has these symptoms, an electrocardiogram (EKG or ECG) test that reads the heart’s electrical activity should be performed to rule out any heart problems.2. Check Your Family History
HCM and other heart conditions are genetic, so tell your pediatrician about any unexplained cardiac death in a sibling, grandparent, aunt, uncle, or cousin under age 50, says Dr. Vetter. Think about less-than-obvious events too. For example, did a family member die in a car accident that had no clear cause? It’s possible that he or she suffered sudden death before the collision. Sudden infant death syndrome (SIDS) could also be due to HCM, so if babies in your family have died of SIDS, let your doctor know.
3. Request an EKG
If your child has a history of fainting or any other symptoms that could point to HCM, Vetter recommends asking your pediatrician for a referral to a pediatric cardiologist for an electrocardiogram test. EKGs in children can be challenging to read, considering the small size of the heart, and specialists can better spot the subtle signs of heart muscle hardening, which can be difficult to see. A health physical and medical history can only identify about 6 percent of HCM patients, but with an EKG, the number goes up to 60 percent, according to Vetter.
If your child is diagnosed with HCM, she'll be monitored closely with regular visits to a pediatric cardiologist. If abnormal activity is detected, your child may become a candidate for an internal defibrillator. Similar to a pacemaker, this device monitors the heart rhythm and shocks it back to normal when necessary.4. Take Your Symptoms Seriously
If you often feel light-headed, tend to faint, or tire easily after exertion, talk to your doctor about it immediately. If you have HCM, there's a 50 percent chance that your child has it too. If the condition is detected early in you, then you can have your child tested before he or she shows any symptoms, preventing a tragedy before it occurs — both for you and for your child.
5. Evaluate Your Child With a Critical Eye
Parents of sports loving kids sometimes ignore the signs of fatigue because they want their children to succeed on the field, says Naidu. Also, your child might not tell you he’s not feeling well out of fear you won't let him play. Compare your child's on-field performance to that of other kids. Does she get winded much more easily? Does he need to sit down more often? Those could be signs that your child's heart is working too hard. “If there’s something that doesn't look right, be honest with yourself and bring it to your doctor’s attention,” says Naidu.
6. Take the Sports Physical Seriously
That form you need your pediatrician to sign before your child can play sports is more than just bureaucratic paperwork. Think about each question as you answer it, and consider the points above regarding symptoms and family history. Lisa Salberg, president of the Hypertrophic Cardiomyopathy Association (HCMA), recommends parents fill out her group’s Pediatric and Young Adult Sudden Cardiac Risk Assessment Form and take it to their pediatrician's office. If you answer yes to any questions on the form, which may be more detailed than typical school forms, Salberg recommends requesting an EKG.
7. Educate Your Schools and Sports Teams
When a person collapses from a cardiac event, a common response is paralyzing shock, says Salberg, who was diagnosed with HCM at age 12. But taking immediate action can save lives. According to the HCMA, early CPR can increase survival odds by 10 percent. Early defibrillation with an automated external defibrillator (AED), which offers an electric shock to restart the heart, raises survival chances by 75 percent. The HCMA’s Dr. Heart Drill offers specific guidance on how to respond in a team-sport emergency scenario.
The thought that something like this can happen to your child is scary, but rest assured that while serious, HCM is rare. Knowing the risks, symptoms, and precautions can give you peace of mind before your child athlete suits up.
Learn more in the Everyday Health Heart Health Center.References:
The following internet links have been gleaned from personal communications
combined with information from public institutions and athletic organizations/
associations that have a web presence with information concerning team and
individual sports programs:
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