Should all teen athletes get EKG tests?


by JEAN ENERSEN / KING 5 Healthlink

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Posted on February 28, 2012 at 7:00 AM

Updated Tuesday, Feb 28 at 9:57 AM

Edwin Jacob plays football and basketball at Franklin High School. He recently came to a youth heart screening event organized by the Nick of Time Foundation at his school.

"Just relax totally, and take a deep breath," said the health care provider who started an electrocardiogram for Jacob.

The electrocardiogram is called EKG, or ECG for short. It records electrical signals of the heart. The test can pick up a heart issue a routine sports physical may miss.

At the end of Edwin Jacob's EKG test? "What this is showing is that you have a perfect heartbeat," his screener said showing the athlete his results.

Seattle Children's Pediatric Cardiologist Dr. Jack Salerno believes EKGs are a valuable tool at screenings like this event, where experienced cardiologists are on hand to interpret the test results.

"The EKG is the part that we think adds value above and beyond the history and physical. If you look even at the American Heart Association they say history and physical may not identify all athletes at risk," he explained.

To protect against rare cardiac arrest, some colleges now give all their players EKGs. But experts debate whether the test should be required for all young athletes. Dr. Salerno is Director of Electrophysiology and Pacing at Seattle Children's. He stopped short of recommending EKGs across the board. They have a high rate of false positives.

"Where we think there's an abnormality but it turns out they don't have them, but they had to have additional care," he explained.

An echocardiogram, or ultrasound of the heart would be the next step to rule out a heart issue that might take an athlete out of play. The costly test still would not prevent every sudden cardiac death.  

"Any funny heartbeats or skipped heartbeats?" Dr. Salerno asked Edwin Jacob as he read down a series of cardiac health questions. "No," Jacob answered.

Dr. Salerno said an EKG adds a layer of reassurance that an athlete's heart is healthy. But he sees another way to improve detection of heart problems in young athletes, a better sports physical. A recent study he co-authored found fewer than 6 percent of doctors in Washington State included all the  questions from the American Heart Association's National Sudden Cardiac Death Guidelines.

According to the guidelines, a proper screening should include questions about chest pain during exercise, and unexplained fainting. And it should require a parent's answers about family history of early death, or heart disease. There are more details in the statement by the American Heart Association, updated in 2007.

"There's a couple questions you answered yes to, the first of which is chest pain with exercise," Dr. Salerno reminded Jacob.

Dr. Salerno is pushing to get a standard form adopted statewide, so  athletes like Jacob, who may need more testing, are identified, and get into the game with healthy hearts.

Dr. Salerno said parents who want the reassurance of an EKG can ask their pediatrician. They can also access the American Heart Association's 12 step screening for young athletes, and take the guidelines to their child's sports physical. There is also more information on sports physicals at the American Academy of Peditatrics website.