12-step screening may help reduce sudden death in young athletes

A 12-point screening process could help reduce sudden cardiac death in high school and college competitive athletes, according to an updated American Heart Association scientific statement.

The Recommendations for Preparticipation Cardiovascular Screening of Competitive Athletes, published in Circulation: Journal of the American Heart Association, revisits the original 1996 statement on this subject and makes no major changes to the mass screening process first recommended at that time. The screening includes 12 questions about personal and family medical history and a physical examination to uncover aspects of a potential athlete's health that could signal a cardiovascular problem:

Personal history

• Chest pain/discomfort upon exertion
  
• Unexplained fainting or near-fainting
  
• Excessive and unexplained fatigue associated with exercise
  
• Heart murmur
  
• High blood pressure
  

Family history

• One or more relatives who died of heart disease (sudden/unexpected or otherwise) before age 50
  
• Close relative under age 50 with disability from heart disease
  
• Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy in which the heart cavity or wall becomes enlarged, long QT syndrome which affects the heart's electrical rhythm, Marfan syndrome in which the walls of the heart's major arteries are weakened, or clinically important arrhythmias or heart rhythms.
  

Physical examination

• Heart murmur
  
• Femoral pulses to exclude narrowing of the aorta
  
• Physical appearance of Marfan syndrome
  
• Brachial artery blood pressure (taken in a sitting position)
  

Parents should verify this information, said members of the expert panel who wrote the statement. If any of the 12 screening elements has a "yes" answer, the participant would be referred for further cardiovascular examination.

The incidence of deaths is in the range of one in 200,000 high school-age athletes per year, based on a 12-year Minnesota study of 1.4 million student-athlete participations in 27 sports.

"Although the frequency of these deaths in young athletes appears to be relatively low, it is more common than previously thought and does represent a substantive public health problem," said Barry J. Maron, M.D., chair of the writing group.