Every three days, a student athlete in the United States dies of sudden cardiac death. The superb conditioning and physical appearance of these young athletes runs contrary to the perception that they could be harboring a serious underlying heart condition. Moreover, most cases of the leading cause of death in this group occur without prior warning symptoms.

How best to detect those at risk ahead of time and take steps to reduce the possibility have sparked a heated debate in the medical community and led to screening programs. Cardiac screening programs that seek heart conditions indicating a predisposition to cardiac arrest are beginning to emerge locally and nationally, but what to include in these studies is still up for discussion. The major problems are that screening every young U.S. athlete may not be feasible and may cause some students to be barred unnecessarily from sports participation.

A history and physical exam may detect some conditions. Others require an electrocardiogram (EKG) or even an ultrasound of the heart (echo). An echo, used to visualize the heart, can estimate overall heart size and function, and look at structures such as heart valves and heart muscle thickness. An echo can detect abnormal thickening of the heart wall, or hypertrophic cardiomyopathy (HCM), a more common causes of sudden cardiac death in U.S. athletes.

Although not all heart conditions which place athletes at risk for sudden death are detectable ahead of time, the American Heart Association (AHA) recommends that screening programs - at a minimum - include a family history, medical history and physical exam of high school and college athletes prior to participation and be repeated every two years. The AHA recommendation does not include the use of a standard EKG. However, in 2004, the Olympic Committee recommended that all athletes have an EKG every two years.

Once thought a very rare condition, more recent estimates of sudden cardiac death cite an occurrence of about one in 200-500 persons. Its cause in athletes is an abnormal heart rhythm. Many of them experience a mild form, never undergoing a life-threatening arrhythmia. The actual stress of athletic competition, accompanied by surges of adrenaline in the bloodstream, is more likely to trigger a potentially fatal or life-threatening arrhythmia. While complaints of fainting spells, shortness of breath or chest pain will likely trigger a doctor’s evaluation; the presence of symptoms prior to a sudden cardiac arrest is the exception rather than the rule. Both physical exams and electrocardiograms can help detect this condition. If the diagnosis is suspected in a student, an EKG can confirm it. Treatment usually includes a medicine known as a beta blocker and possibly an implantable defibrillator.

Beaumont Hospital in Royal Oak, Michigan, like some other medical institutions, has performed several screenings at no charge for local high school student athletes prior to their participation in sports. Beaumont’s screenings included an EKG for all students; and echo for some. In screening more than 2,000 athletes, only one has been barred from sports participation with HCM.

Furthermore, countries such as Italy, which have adopted more extensive screening programs requiring an EKG, report fewer instances of sudden death in their young athletes compared with previous eras. Interestingly, the most common cause of sudden death in Italian athletes is an arrhythmia, which is different from the U.S., where other cardiac conditions also include congenital disorders of the heart’s circulation.

Besides screening, life saving treatment for sudden cardiac death in student athletes should be immediately available. Coaches and athletes can be trained in CPR (cardiopulmonary resuscitation) and taught to use an AED (Automatic External Defibrillator), which quickly restore the heart rhythm to normal. These FDA-approved devices are being made accessible at athletic facilities and have been proven to save lives. Some groups also recommend having a written emergency plan in place.

While most agree that making AEDs more widely available is beneficial, screening of student athletes is still controversial. In the future, genetic screening will help to streamline screening and identify those at risk, but most experts agree that currently, this type of testing is not yet “ready for prime-time.” Costs and overall benefit of widespread screening program will have to be addressed in the future in a more scientific way. Certainly, any parent or coach who has lost a student to sudden cardiac death would believe differently. For now, saving one life seems to be worth the time and trouble.

Pamela Marcovitz M.D. is the director of the Ministrelli Women’s Heart Center at Beaumont Hospital, Royal Oak. Opened in 2002, the Ministrelli Women’s Heart Center is the first and only cardiac center in Michigan designed expressly for the prevention, diagnosis and research of women’s heart disease. This state-of-the-art facility features on-site diagnostic capabilities, including stress tests, EKGs and echocardiograms (heart ultrasounds). To receive more information on heart disease or the Ministrelli Women’s Heart Center, please call 248-898-4760.