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More Heart Screening Called for in College-Level Athletics

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Henry S. Miller, MD, a cardiologist with the Wake Forest University School of Medicine in Winston-Salem, N.C., has examined many athletes in his day. He says his school had a wake-up call when a swimmer with Marfan's syndrome, a genetic condition that weakens the blood vessels and heart, died while swimming laps. Marfan's syndrome is an AHA warning sign. "We didn't know anything about his family history. ... [It was] a tragic situation ... that precipitated us getting a lot more information from family and physicians," Miller tells WebMD.

"The most important thing is to be able to get a really good history of these people," Miller says. Wake Forest uses the histories to "augment" on-campus examinations done by cardiologists, or physicians experienced with heart conditions, and orthopaedic surgeons. "Our duty is to keep them alive, and their duty is to see if they can play."

Less than 10% of schools in the JAMA survey routinely performed tests such as EKGs, chest X-rays, or echocardiograms, which can effectively find some of the heart conditions, usually congenital, that can bring on sudden death.

Division I schools, which generally have the largest intercollegiate sports programs and scholarship awards, were usually found to have more comprehensive screening programs than Division II or III schools. Beyond the standard screening, noninvasive tests like EKGs or X-rays "are costly and impractical for most schools," the authors write.

"There are many conditions that are even blind to the best screening because they're very complex. ... So, the principle that's being followed here is not the expectation that most would be identified, but that if we did a better job, more would be identified, or suspected at least. ... We're not going to be able to add tests, so we have to do the physical examination and history better to increase the number of detections," Maron tells WebMD.

"I think a lot of people make light of [screening] because there's so many [student athletes] coming through and rarely anything ever happens," Miller tells WebMD. "But you don't need but one happening to make you think you should have done a lot of things differently. ... What is the minimum you can get by with and what is the maximum? Those are the things that are discussed in that article."

Although Miller says they found problems at Wake Forest "very infrequently, I can only think of three or four people over many years ... [screening] will pick one or two out of the 200 that we see, that we couldn't let do what they came there to do." But if you get one life out of it, it's worth it, he says.

Vital Information:

  • Doctors recently surveyed how thoroughly colleges screen their athletes for conditions that could cause sudden death while competing. They collected nearly 900 responses and found that almost every school required a formal medical screening and family medical history before participation in sports.
  • Most of the exams were performed by orthopaedic surgeons, who the researchers say would not be as familiar with heart conditions as would primary care doctors or cardiologists. And one in four schools used inadequate screening forms.
  • Observers note that it's a rare event to have an athlete suffer sudden death. But more can be done overall to catch the few students at risk before a tragedy happens.
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