eWellness: Children should be screened for the heart before playing any sports |
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eWellness: Children should be screened for the heart before playing any sports

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Sudden cardiac death amongst athletes is a rare but a devastating event. Most victims are usually young and, apparently, healthy but many have underlying undiagnosed heart disease. As per American Heart Association Guidelines, children and adolescents undergoing athletic training need medical clearance. Majority of sudden deaths amongst athletes are due to malignant irregularities in the heart rhythm such as ventricular tachycardia and ventricular fibrillation. The precipitating factors can be prolonged physical training or unaccustomed athletic activities. In athletes under the age of 35, the most common cause of death is underlying congenital heart disease and for those above the age of 35, it is the presence of blockages of the coronary arteries. The Heart Care Foundation of India recommends that, in every school/college, the attached doctor should evaluate all students with a 12 step history and examination to rule out high risk cases that need further evaluation. The Foundation, along the lines of European Society of Cardiology, also recommends an additional standard 12–lead ECG before a medical clearance is given for both competitive as well as recreational athletic activities. Master athletes who are above the age of 35 will need an additional exercise testing before they can be given a clearance for athletic activity. Diagnostic echocardiography is indicated when clinical, historical and physical findings suggest possibility of structural heart diseases. Athletes on pacemakers should not engage in sports as bodily collision may damage the pacemaker system. The 12–element AHA recommendations for pre participation cardiovascular screening of competitive athletes are as follows:

Exertional chest pain/discomfort

  1. Unexplained syncope/near–syncope

  2. Excessive exertional and unexplained dyspnea/fatigue, associated with exercise

  3. Prior recognition of a heart murmur

  4. Elevated systemic blood pressure

  5. Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in one relative

  6. Disability from heart disease in a close relative <50 years of age

  7. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long–QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias

  8. Heart murmur

  9. Femoral pulses examination to exclude aortic coarctation

  10. Physical features of Marfan syndrome

  11. Brachial artery blood pressure (sitting position, both arms)

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