DALLAS -- Pre-participation cardiovascular evaluation of young competitive athletes to rule out Marfan syndrome, murmur, aortic coarctation, and hypertension could reduce the risk of sudden death, contend new guidelines.
DALLAS, March 13 -- Pre-participation cardiovascular evaluation of young competitive athletes to rule out Marfan syndrome, murmur, aortic coarctation, and hypertension could reduce the risk of sudden death, contend new American Heart Association guidelines.
But the AHA, outlining a 12-step cardiovascular screening protocol that includes family and personal medical history as well as a physical examination, said there was no need for routing ECG screening of high school and college athletes.
The recommendations came in a scientific statement from the AHA's Council on Nutrition, Physical Activity, and Metabolism, which was published online by Circulation, Journal of the American Heart Association. The statement was also endorsed by the American College of Cardiology Foundation.
The AHA said sudden deaths of athletes were "usually due to a variety of unsuspected cardiovascular diseases and have been reported with increasing frequency in both the United States and Europe."
The European Society of Cardiology and the International Olympic Committee addressed the problem by recommending that competitive athletes be evaluated with a 12-lead electrocardiogram prior to competition, but the AHA disagreed.
Barry J. Maron, M.D., of the Minneapolis Heart Institute, who chaired the writing committee, said the "AHA panel does not believe it to be either prudent or practical to recommend routine use of tests such as 12-lead ECG or echocardiography in the context of mass, universal screening."
At this time, Dr. Maron said, the U.S. has neither the money nor the trained professionals that would be needed to carry out such large-scale ECG or echocardiography screening.
Instead the AHA recommended a few noninvasive tests designed to "enhance the diagnostic power of the standard history and physical examination."
Those four noninvasive tests are:
These tests should be evaluated along with information obtained from a medical history that includes a five-part personal history and a three-part family history.
Personal history should include:
Family history should include:
Dr. Maron said that a "positive response or finding in any one or more of the 12 items may be judged sufficient to trigger a referral for cardiovascular evaluation."