Heart Failure in Young Athletes

This is something that really needs to be done....From the HeartWaves blog, Holly touches on the need to have young athletes screened.


Over 10 million adolescents participate in extracurricular sports activities every year in theUnited States. Despite the many advances in medical care and the performance of sports physicals, a significant number of teenage athletes die without warning every year. One to two per 200,000 student athletes die of sudden unexpected deaths while participating in athletic games every year. Sudden cardiac death (SCD) is defined as death of cardiac origin that occurs within several hours of the usual state of health and is unanticipated and not related to trauma or other organ disease. The death of young, apparently healthy individuals who are considered to be at the pinnacle of fitness, impacts upon sport, their peers, family and friends and the community as a whole.

Many of the cardiovascular abnormalities that cause sudden cardiac death in athletes exhibit no signs or symptoms prior to the lethal event. The cause of sudden death in athletes is usually an underlying cardiovascular disorder, which includes inherited and congenital heart diseases. Hypertrophic Cardiomyopathy (HCM) was found to be the most common cause of death in student athletes, accounting for over thirty percent of the cases. Other conditions that lead to sudden cardiac death in athletes include congenital coronary artery anomalies, Marfan syndrome, and cardiac electrical-conduction abnormalities.

Students who wish to participate in extracurricular sport activities are required to have a preparticipation physical evaluation. Preparticipation cardiovascular screening is the systematic practice of medically evaluating large, general populations of athletes before participation in sports for the purpose of identifying (or raising suspicion of) abnormalities that could provoke disease progression or sudden death. The current recommendation from the American Heart Association for student athletes is to have a physical examination every two years at a minimum. The preparticipation physical evaluation was created over 20 years ago to provide a method to provide medical clearance for athletes who might be at risk for sudden death from physical activity.

The time designated for the preparticipation physical evaluations also serves as a time for a routine health maintenance exam. The athletic preparticipation physical exam has become a standard of care for high school students across the nation to participate in extracurricular sport activities. In theUnited States, the pre-participation evaluation includes obtaining a thorough personal and family health history and the physical examination.

The American Academy of Pediatrics released guidelines for healthcare providers to follow to determine eligibility for sports participation in screening individuals with common medical conditions. Approximately 10% of students require further evaluation for abnormal findings either in the history or upon examination and over two percent will be completely excluded from all sports participation. If any concerns are noted in the medical history or if an abnormality is found during physical examination, the individual will be referred to a specialist for further evaluation, where clearance can be determined. The important message for all parents and students to understand is that while this sports physical exam and history is thorough, it is not an exact science, it is simply a screening process. Routine health examinations and follow-up are essential to the well-being of all individuals. If there are any concerns the student or parent may have, they should discuss them with their primary health care provider.

Holly Tomlin