Lawmakers in Harrisburg recently decided that there needed to be a section on sudden cardiac arrest (SCA) placed in student athletes’ pre-participation physicals to make sure that parents understood that there are risks from SCA and sports. This, unfortunately, has caused some confusion in the world of high school athletics.
SCA is defined as an abrupt, complete loss of heart function that results in loss of blood circulation within the body. This can lead to sudden cardiac death.
Screening for heart issues happens during the pre-participation physical, usually held in the summer for the next school year. The screening specifically asks about exertional chest pain, lightheadedness or muscular weakness, fainting, excessive shortness of breath and palpitations. Family history of premature death should also be answered. It is important that the athlete truthfully answer these questions so that the physician may be able to assist the athlete further.
Physicians, who do these sports physicals, want the athlete to play. Some athletes might feel that the physician is intentionally holding them from participation. This is not the case. Athletes have to understand that the physician is there to help them. After the history is done with the athlete, a physical exam, specifically looking for a heart murmur, must be completed. Further testing is then decided if any of these answers are positive.
There are limitations to the pre-participation physical: 50 to 80 percent of athletes have no signs or symptoms prior to their first SCA. Currently, there is no way to prove that the physical will indeed decrease sudden cardiac death. Increasing the amount of testing is currently not economical. Annual screening with just an EKG would cost more than $2 billion for all the high school athletes in the United States. It is unfortunate, but true, that money is the driver. The cost-benefit ratio is too high as just 1 in 200,000 athletes per year are diagnosed with SCA.
This may seem dreary, but realize that new technologies are on the horizon—ones that should decrease the cost and make it easier for testing to occur in the future.
Matthew F. Wilson, DO, practices at PinnacleHealth FamilyCare in Silver Spring.
