Pre- Participation screening forestall sudden deaths

An Italian based study revealed that screening athletes for hidden heart problems can help reduce sudden fatalities and cutting death rates.

The study based on the tests of more than 40,000 Italians is published in the October 4th issue of the Journal of the American Medical Association. The study began in 1979 and concluded in 2004, showing that over the years, the death rates have declined sharply due to screening.

After the screening was started in 1979 on athletic and non-athletic young people in the Veneto region of Italy, by 2004, the rate of sudden cardiac deaths dropped by 89 percent - from 3.6 to 0.4 per 100,000 person/years.

"All these findings suggest that screening athletes for cardiomyopathies is a lifesaving strategy," the report said.

Cardiomyopathy, the deterioration of the function of heart muscle for any reason, typically leads to signs and symptoms of heart failure as the pumping efficiency of the heart is diminished. People with cardiomyopathy are often at risk of arrhythmia and/or sudden cardiac death.

The team of cardiologist researchers at the University of Padua Medical School also noted that 2% athletes were unfit for competitions due to medical reasons.

Dr. John P. Payne, director of cardiac electrophysiology at the University of Mississippi Medical Center said that the medical community has been giving consistent attention in the issue of sudden death’s of young athletes, and in the past few years, the attention has escalated.

He added that about 200 to 400 athletes collapse on the playing field due to cardiac arrest each year in the United States, but there are no accurate public health measures available right now.

The American Heart Association urges that a screening should be done for high school and college athletes before they compete. This would include a physical check up and recording of the family history, which is the most crucial part, as many types of cardiomyopathies are inherited.

Eectrocardiogram (ECG), a graphic produced by an electrocardiograph, which records the electrical voltage in the heart in the form of a continuous strip graph, is the key tool in cardiac electrophysiology, and has a prime function in screening and diagnosis of cardiovascular diseases. The European authorities recommend the would-be athletes to undergo ECG. In fact, the Italian report ascribes much of the success of their programme to regular screening via ECG’s.

However, American sports organizations such as the National Athletic Trainers Association, recently issued the screening guidelines, but did not support screening via ECG and hold that many young people are wrongfully identified as having problems on the basis of an ECG.

Payne, disaccording with that assessment, said that each athlete should be "thoroughly screened (for heart problems) by a trained health-care provider. I think it should be done by a personal physician, with an ECG."

He said by detecting abnormalities at an early stage, many lives can be saved, as potential treatment can be provided at the right time.

The systematic study introduced in Italy, screened athletes in the age group on 12 to 35. Dr. Gaetano Thiene, of the Centre for Sports Medicine in Padua, Italy, said that pre-participation screening is a life-saving tool, which helps in identifying athletes with heart problems, disqualifying them if need be.

Researcher Greg Wells, from Toronto's Hospital for Sick Children, is part of a group recommending that a similar program be implemented in Canada.

"The key message to take away from this study is that we can screen our athletes for cardiac problems and Canada should be moving down this road as quickly as possible," he said.

Presently, only professional athletes or those heading for Olympics undergo such screening. Doctors suggest that until more rigorous precautions are enforced, the families should be on the look out for symptoms, which include shortness of breath, dizziness or fainting, chest pain, and fatigue.