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Adding Electrocardiography to Medical History and Physical Examination for Evaluation Before Sports Participation in College Athletes FREE

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Ann Intern Med. 2010;152(5):I-13. doi:10.7326/0003-4819-152-5-201003020-00001
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In the United States, estimates are that sudden death occurs in about 1 of every 220 000 young sports participants. Previously unknown heart disease is the leading cause of these deaths. Major medical organizations recommend that young athletes be evaluated for heart disease before they participate in organized sports. However, recommendations about how to evaluate young athletes vary. The American College of Cardiology and the American Heart Association recommend a medical history and physical examination, with further testing if history or examination is abnormal. The European Society of Cardiology and the Olympic Committee recommend including electrocardiography (ECG). This test records the electrical impulses in the heart and provide information about abnormal heart rhythms and other heart conditions.

Why did the researchers do this particular study?

To find out whether adding ECG to history and physical examination would help to find athletes with heart problems that would make it dangerous for them to participate in sports.

Who was studied?

510 athletes preparing to participate in varsity-level sports at Harvard University, Cambridge, Massachusetts.

How was the study done?

All athletes underwent a standard presport medical history, physical examination, and ECG. Every athlete also had echocardiography. Echocardiography is more difficult to perform and read than ECG, which makes it less feasible for presport evaluation. However, the researchers used the echocardiograms to find out which athletes truly had heart problems that might make sports participation dangerous. They then saw how many cases of echocardiogram-proven heart disease were found with history and examination alone compared with plus ECG.

What did the researchers find?

Of the 510 athletes, 11 had heart abnormalities found on echocardiography that might make it dangerous for them to participate in sports. History and examination alone identified 5 of these 11 athletes with heart conditions. Adding ECG to history and physical examination found 10 of these 11 athletes. However, 83 of the ECGs were abnormal and would have led to further testing, worry, or exclusion from sports participation in a substantial number of athletes who had normal hearts.

What were the limitations of the study?

This study could not determine whether identification of the abnormalities actually led to fewer sudden deaths. Because many of these college athletes had previous presports screening, the results might not apply to young athletes who are completely new to sports participation.

What are the implications of the study?

Adding ECG to history and physical examination of young athletes increases the number of athletes with heart disease who are identified. However, many athletes without dangerous heart disease would also have abnormal ECGs. This means that further testing, worry, and exclusion from sports could occur in athletes with normal hearts.







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