this issue of NEJM has an article on role of cardiac screening pre-sports participation (see\u00a0DOI: 10.1056\/NEJMclde1311642. article presents differing views on the appropriate extent of screening, esp whether to use EKG as part of the screen, noting that:<\/p>\n
–not common (around 100-150 young athletes die\/yr in US), pales in comparison to numbers of youth who die from accidents, homicide, suicide, and even non-exercise assoc sudden death<\/p>\n
–still obviously a very tragic event when it happens, typically unsuspected in apparently totally healthy, vigorous person<\/p>\n
–everyone agrees to do pre-athletic screen with history\/physical, best with standardized screen, assessing cardiac history of family and patient (eg \u00a0dizziness,\u00a0fainting, chest pain, shortness of breath and\u00a0palpitations during or after exercise, or a change\u00a0in exercise tolerance). \u00a0but family history only picks up 16% and only 1\/2 have antecedant symptoms prior to sudden death<\/p>\n
–really important to focus on high school kids, since 65% of deaths in young athletes are in high school kids<\/p>\n
so, you can read the pros and cons, but i thought i’d send along a reference from the british journal of sports medicine which has consensus criteria on the abnormal EKG in athletes (one issue with doing EKGs in these kids is the large number of false positives, leading to some unnecessary testing and unnecessary exclusion from sports) —\u00a0see\u00a0\u00a0doi:10.1136\/bjsports-2012-092067<\/p>\n
here is the summary table:<\/p>\n
Table 1 Abnormal ECG findings in athletes<\/p>\n
Abnormal ECG finding <\/b>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Definition<\/b><\/p>\n
T-wave inversion \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 >1 mm in depth in two or more leads V2\u2013V6, II<\/p>\n
and aVF, or I and aVL (excludes III, aVR and V1)<\/p>\n
ST segment depression \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u22650.5 mm in depth in two or more leads<\/p>\n
Pathologic Q waves \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0>3 mm in depth or >40 ms in duration in two or<\/p>\n
more leads (except for III and aVR)<\/p>\n
Complete left bundle\u00a0branch block\u00a0 \u00a0\u00a0\u00a0 \u00a0\u00a0QRS \u2265120 ms, predominantly negative QRS<\/p>\n
complex in lead V1 (QS or rS), and upright<\/p>\n
monophasic R wave in leads I and V6<\/p>\n
Intraventricular conduction\u00a0delay\u00a0 \u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0Any QRS duration \u2265140 ms<\/p>\n
Left axis deviation \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u221230\u00b0 to \u221290\u00b0<\/p>\n
Left atrial enlargement \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Prolonged P wave duration of >120 ms in leads I<\/p>\n
or II with negative portion of the P wave \u22651 mm in<\/p>\n
depth and \u226540 ms in duration in lead V1<\/p>\n
Right ventricular\u00a0hypertrophy pattern\u00a0 \u00a0\u00a0R\u2212V1+S\u2212V5>10.5 mm AND right axis deviation<\/p>\n
>120\u00b0<\/p>\n
Ventricular pre-excitation \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0PR interval <120 ms with a delta wave (slurred<\/p>\n
upstroke in the QRS complex) and wide QRS<\/p>\n
(>120 ms)<\/p>\n
Long QT interval* \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0QTc\u2265470 ms (male)<\/p>\n
QTc\u2265480 ms (female)<\/p>\n
QTc\u2265500 ms (marked QT prolongation)<\/p>\n
Short QT interval* \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 QTc\u2264320 ms<\/p>\n
Brugada-like ECG pattern\u00a0\u00a0 \u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0 \u00a0\u00a0High take-off and downsloping ST segment<\/p>\n
elevation followed by a negative T wave in \u22652<\/p>\n
leads in V1\u2013V3<\/p>\n
Profound sinus bradycardia \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<30 BPM or sinus pauses \u2265 3 s<\/p>\n
Atrial tachyarrhythmias \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0Supraventricular tachycardia, atrial-fibrillation,<\/p>\n
atrial-flutter<\/p>\n
Premature ventricular\u00a0contractions\u00a0 \u00a0\u00a0\u00a0 \u00a0\u00a0\u22652 PVCs per 10 s tracing<\/p>\n
Ventricular arrhythmias \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0Couplets, triplets and non-sustained ventricular<\/p>\n
tachycardia<\/p>\n
Note: These ECG findings are unrelated to regular training or expected<\/p>\n
physiological adaptation to exercise, may suggest the presence of<\/p>\n
pathological cardiovascular disease, and require further diagnostic evaluation.<\/p>\n
*The QT interval corrected for heart rate is ideally measured with heart rates of<\/p>\n
60\u201390 bpm. Consider repeating the ECG after mild aerobic activity for borderline or<\/p>\n
abnormal QTc values with a heart rate <50 bpm.<\/p>\n
<\/p>\n
geoff<\/p>\n","protected":false},"excerpt":{"rendered":"
Cardiac screening pre-sports and abnormal ECGs […]<\/p>\n