Recently, there has been much discussion regarding concussion and sudden cardiac death (SCD) in young athletes. Although this is rare in children and adolescents, they are so devastating when it happens. There has been a growing effort in finding evidence-based strategies that will prevent this in a cost-effective manner.
How common is this?
The incidence for SCD ranges 0.5 to 20 per 100,000 persons-years. Interestingly, when we compare studies from 1980s to 2009 show a rise in survival, which is attributed to improvements in community-based EMS and changes in resuscitation protocols.
What is the cause?
2 years old and younger - cause of death congenital heart disease (84%)
3-13 years old - No dominant cause - congenital (21%), hypertrophic cardiomyopathy (18%), long QT
14-24 years old - No dominant cause - Primary arrhythmia (23%), congenital (23%), and dilated
hypertrophic cardiomyopathy (14%)
25-35 years old - Coronary artery disease
When should I be concerned?
What is the role for screening?
The American Heart Association (AHA) and the American Academy of Pediatrics (AAP) recommend that the most cost-effective initial screening for children and adolescents for cardiac disease is a detailed history and physical examination - ALONE. That is right, no need for unnecessary expensive testing no matter how some of these organizations market their services.
There NO evidence that a ECG or any other cardiovascular screening program would reduce the incidence of SCD in the United States.
Even for young athletes, there is NO evidence for routine use of ECG, echocardiography, or exercise stress testing. However, athletes older than 35 years old, some experts recommend ECG. If the athlete who is 35 years and older has moderate-to-high risk of coronary heart disease, then some experts would recommend exercise stress testing.
Bottom line: Be careful out there as consumers are inundated with advertisements for services that can prevent cardiac disease. The truth is that unnecessary testing not only is costly, but also leads to false-positives that lead to further unnecessary testing. As with every health care topic - have a GOOD PRIMARY CARE DOCTOR to discuss issues like this and build a relationship with them so that you protect yourself from unnecessary testing that can be costly or lead to further unnecessary procedures that might expose you to harmful agents like radiation.
To your health my friends,
- Dr. Ahmed
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