Spotting Sudden Death Risk in Athletes

March 14, 2007 -- A 12-step screening process may help prevent sudden death among young athletes.

New guidelines issued by the American Heart Association recommend asking young athletes a series of questions about their personal and family medical history as well as performing a physical exam to reveal their risk of sudden death.

Sudden death affects about one in 200,000 high school athletes a year and has been reported with increasing frequency in the U.S. and Europe. The most common causes of these sudden deaths include structural heart problems.

"Although the frequency of these deaths in young athletes appears to be relatively low, it is more common than previously thought and does represent a substantive public health problem," says researcher Barry J. Maron, MD, of the Minneapolis Heart Institute Foundation, in a news release.

In the U.S., these deaths most commonly occur in popular, high-intensity sports like football and basketball.

Spotting Signs of Sudden Death

In the guidelines, published in Circulation: Journal of the American Heart Association, researchers call for widespread screening of young athletes to assess their risk of sudden death.

The 12-step screening process includes eight personal and family medical history questions and a brief physical examination:

Personal history

1. Chest pain/discomfort upon exertion
2. Unexplained fainting or near-fainting
3. Excessive and unexplained fatigue associated with exercise
4. Heart murmur
5. Elevated blood pressure           

Family history

6. One or more relatives who died of heart disease (sudden/unexpected or otherwise) before age 50
7. Close relative under age 50 with disability from heart disease
8. Specific knowledge of certain cardiac conditions in family members

The physical exam includes screening for four potential signs of heart problems, including heart murmurs, elevated blood pressure, femoral pulses, and Marfan syndrome. A check of femoral pulses is used to look for a problem with the aorta. Marfan syndrome is an inherited condition that affects the heart and blood vessels, among other areas of the body.

Researchers say athletes who answer “yes” to any of the screening questions or have a positive finding in the physical exam should be referred for further cardiovascular evaluation.

Researchers say there is some debate about whether widespread screening of young athletes should include an electrocardiogram (ECG) to read the heart’s electrical activity. But Maron says the recommendations don’t include ECG screening due to a lack of infrastructure to support it.