Adding Electrocardiography to Medical History and Physical Examination for Evaluation Before Sports Participation in College Athletes. Ann Intern Med. 2010;152:I-13. doi: 10.7326/0003-4819-152-5-201003020-00001
Download citation file:
Published: Ann Intern Med. 2010;152(5):I-13.
In the United States, estimates are that sudden death occurs in about 1 of every 220 000 young sports participants. Previously unknown heart disease is the leading cause of these deaths. Major medical organizations recommend that young athletes be evaluated for heart disease before they participate in organized sports. However, recommendations about how to evaluate young athletes vary. The American College of Cardiology and the American Heart Association recommend a medical history and physical examination, with further testing if history or examination is abnormal. The European Society of Cardiology and the Olympic Committee recommend including electrocardiography (ECG). This test records the electrical impulses in the heart and provide information about abnormal heart rhythms and other heart conditions.
To find out whether adding ECG to history and physical examination would help to find athletes with heart problems that would make it dangerous for them to participate in sports.
510 athletes preparing to participate in varsity-level sports at Harvard University, Cambridge, Massachusetts.
All athletes underwent a standard presport medical history, physical examination, and ECG. Every athlete also had echocardiography. Echocardiography is more difficult to perform and read than ECG, which makes it less feasible for presport evaluation. However, the researchers used the echocardiograms to find out which athletes truly had heart problems that might make sports participation dangerous. They then saw how many cases of echocardiogram-proven heart disease were found with history and examination alone compared with plus ECG.
Of the 510 athletes, 11 had heart abnormalities found on echocardiography that might make it dangerous for them to participate in sports. History and examination alone identified 5 of these 11 athletes with heart conditions. Adding ECG to history and physical examination found 10 of these 11 athletes. However, 83 of the ECGs were abnormal and would have led to further testing, worry, or exclusion from sports participation in a substantial number of athletes who had normal hearts.
This study could not determine whether identification of the abnormalities actually led to fewer sudden deaths. Because many of these college athletes had previous presports screening, the results might not apply to young athletes who are completely new to sports participation.
Adding ECG to history and physical examination of young athletes increases the number of athletes with heart disease who are identified. However, many athletes without dangerous heart disease would also have abnormal ECGs. This means that further testing, worry, and exclusion from sports could occur in athletes with normal hearts.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Cardiology, Cardiac Diagnosis and Imaging.
Results provided by:
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only