As a parent and pediatrician, any mention of sudden cardiac death leaves me feeling uneasy. The stories of young athletes dying or falling on the field are agonizing. All of us here on earth would like to do something to prevent these deaths.
Researchers and cardiologists are working tirelessly to understand predictors for sudden cardiac death in children alongside techniques to improve screening and prevention for young athletes. Dr Nicolas Madsen talked with me about recent work here in Washington State. There’s a video at the end of this post from the interview. I’m lucky, I met Dr Madsen when he was a medical student and now he’s an old friend. He’s one of those bright lights: a compassionate physician and father of three who just gets it and wants to solve big problems. He’s about to finish his fellowship here in Seattle and while completing his training, he’s uncovered some holes in the system. He’s helped me understand how to screen children better. As a parent, there are some simple things you can do to improve the screening your child receives prior to athletic participation.
“Sudden Cardiac Death is a needle in a haystack, but a very sharp one.”
Statistics on Sudden Cardiac Death
- Sudden cardiac death is rare. Studies vary in the incidence but it occurs anywhere between 1 in 300,000 athletes to 1 in 30,000 athletes depending on which study you use. Fortunately, there are some predictors for sudden cardiac death (SCD), as it tends to occur in families. If you have a family history of SCD or a sudden death from heart disease prior to age 50, or if your child has ever passed out/blacked out during exercise or complains about chest pain with sports, talk with your child’s physician prior to any athletic endeavor. Do this now.
- 90% of SCD occurs during or shortly after exertion or exercise, the mean time in life is around 17-23 years of age. Basketball and soccer are the most common sports where SCD occurs (reasons not entirely clear).
- Cardiomyopathies (swollen or misshapen hearts), anatomic abnormalities (congenital and acquired), and arrhythmias (rhythm changes) can all cause SCD in young athletes.
- A sports screening exam (“Sports physical”) or preparticipation physical evaluation (PPE) is the way we screen for sudden cardiac death in the United States. Trouble is, the sports physical may vary widely from one physician to another.
- The American Heart Association put out guidelines for SCD screening that include 8 family & medical screening questions and 4 physical exam findings. Many physicians are unfamiliar with these–I learned quite a bit prepping this post.
Although 44 states require screening of athletes, not all parents and pediatricians/family docs/nurse practitioners know the recommendations. Further, every school seems to have a different form! Dr Madsen and his colleagues set out to determine how Washington State was doing on screening young athletes. The news isn’t as good as we’d like.
- Cardiologists surveyed 371 athletic directors and 1100 pediatricians & family physicians in WA State. They had very good response rates (over 70% of athletic directors and pediatricians, and over 50% of family doc who were asked responded).
- Athletic directors: 55% of the schools required a sports form but 0% (read: none) of the schools in WA state were current with the American Heart Association’s guidelines. Only 6% of the athletic directors were familiar with the recommendations. But most (66%) of the athletic directors would like a statewide form!
- Doctors: Only 45-50% of physicians doing sports physicals were familiar with the AHA guidelines and recommendations while less than 6% of physicians adhered to the full AHA sudden cardiac death screening guidelines.
What Parents Can Do To Protect Their Children From Sudden Cardiac Death:
- Print out a pre-participation sports physical examination form NOW. Use this form for every sports physical your child has as it prompts the physician to ask and assess the history and physical exam findings recommended for properly screening children. Also find additional forms for children with special needs, history taking forms, and sports clearance forms here at the American Academy of Family Physicians website. Have your child’s physician complete this for the school.
- Ask family members about any history of cardiac death prior to age 50 years, any unexplained death, or any drownings in your family prior the your child’s start in sports.
- If any concerns about heart murmurs, history of fainting with exercise, family history of cardiac or unexplained death, high blood pressure, or complaints of chest pain during and with exertion or sports — go see the doctor. Ask about an EKG/ECG.
- ECGs are good at screening for sudden cardiac death. If any concerns about your child’s heart or any concerns about your family’s history, advocate that your child has an EKG.
- Ensure your child’s school, athletic team, and coach have an AED (automated external defibrillator) available during all sporting events. Ask and help make sure team coaches and directors know how to use an AED.
Ask questions here. Get your kids out there and enjoy sports. Download these forms. Share the links for the sports forms with your friends and with your child’s athletic director. And then rest easier knowing you’ve done what you can do to improve protection for your child. Dr Madsen will stop by and assist with questions as needed.