Shouts from the Stands: Heart Screenings in High School Athletes

SwimSwam welcomes reader submissions about all topics aquatic, and if it’s well-written and well-thought, we might just post it under our “Shouts from the Stands” series. We don’t necessarily endorse the content of the Shouts from the Stands posts, and the opinions remain those of their authors. If you have thoughts to share, please send [email protected]

This “Shouts from the Stands” submission comes from Chelsea Gravereaux:

We can all agree that swimming is the most fun sport.  On the other hand, swimming, like all other sports, is dangerous, and injuries are not uncommon.  The grind of two practices a day, the strain of weightlifting at the gym, and the pressure to be the best make swimming rough and lead to injuries.  Bumps, bruises, and cuts are some of the lesser injuries that athletes can get.  Those will heal in a few days, while other injuries, such as heart conditions, will last a lifetime.  Heart problems can make swimming incredibly dangerous, sometimes even deadly, especially if athletes are competing or training with hidden, undiagnosed conditions.  It is estimated that, “roughly 66 athletes die from sudden cardiac arrest each year” (American, 2015).  Luckily, heart problems can be diagnosed during preseason physicals to avoid sudden cardiac arrest, or even death.   Currently, preseason physicals are different at every school and advocates are fighting for universal heart screenings.

Echocardiograms, electrocardiograms, and pre-sports checklists are three types of heart screenings that advocates are fighting for.  In general, heart screenings have become more accurate, cheaper, and easier to conduct due to new technology.  If an athlete has an abnormal heart screening, they will need to have more tests conducted to determine the issue, before it is too late.  Heart screenings can ultimately identify heart conditions, and therefore prevent sudden cardiac arrest.  All high school athletes should have heart screenings conducted prior to the beginning of the season because it will allow participation to be tailored and prevent premature death.

To put it plainly, undiagnosed heart conditions can be life-threatening.  Preseason heart screenings can be used to detect these conditions.  If a swimmer has a heart problem and continues to participate in sports, the condition can be aggravated and the athlete could go into sudden cardiac arrest.  Sudden cardiac arrest, or SCA, occurs without warning when the heart beats too fast and interrupts the blood flow to vital body organs.  Sudden cardiac death, SCD, occurs if SCA is not treated within just a few minutes (Young Athletes, 2018).  A heart screening conducted prior to the season could identify the problem and then steps can be taken to prevent sudden cardiac arrest from occurring.  Unfortunately, “people with heart disease have a greater chance of SCA” (Sudden, n.d.).  Physical stress, such as swim practices, can be a trigger for SCA in people with heart diseases (Sudden, n.d.).  This makes participating in sports even more dangerous for athletes who have heart problems.  If an athlete does not know that he/she has a heart problem, then they can not do anything to prevent sudden cardiac arrest and they are unknowingly more at risk.  Therefore, it is key that heart diseases and conditions be diagnosed with heart screenings to prevent the athlete’s health from worsening.

Once a condition is diagnosed, the athlete’s exercise and participation in sports can be tailored to fit his/her cardiac needs.  Too much exercise for athletes with heart problems is dangerous and can cause SCA.  Preseason physicals with heart screenings can, and will, help prevent SCA by identifying heart conditions and allowing the athlete’s participation to be tailored.  After all, heart screenings are about preventing sudden cardiac arrest by identifying heart problems in athletes before sudden cardiac arrest happens.  Heart screenings will help athletes by identifying dangerous heart conditions and tailoring their activities to prevent sudden cardiac arrest.

Heart screenings will ultimately decrease the number of sudden cardiac arrests in young athletes.  Implementing mandatory heart screenings in young athletes, finding a hidden heart condition, and then tailoring the exercise of athletes with heart problems will lower both the risk and the number of athletes who suffer from SCA.  The hope is to find an undiagnosed heart condition that could cause sudden cardiac arrest and then prevent any cardiac events thanks to early detection (Lawless, 2012).  Current routine preseason physicals make it unlikely to find life-threatening heart conditions.  Instead, echocardiograms, electrocardiograms, or more thorough heart screenings should be required to identify heart diseases that will prevent sudden cardiac arrest, and ultimately, death.  Using the pre-sports checklist created by the American Heart Association increases the sensitivity of finding hidden heart conditions to 40-50%, much higher than the current 2.5-6% sensitivity rate of pre-participation physicals  (Lawless, 2012).  Adding a mandatory heart screening such as the AHA pre-sports checklist will successfully identify more heart conditions.  Having more accurate, universal heart screenings will diagnose more heart conditions, therefore allowing athletes to exercise accordingly to prevent sudden cardiac arrest.

Heart screenings will reduce the number of lives lost from sudden cardiac death.  Implementing heart screenings as part of routine preseason physicals will save lives by identifying young athletes who are at risk, before they go into sudden cardiac arrest (Heart Screening, 2010).  Italy made heart screenings mandatory for athletes in 1982.  Since then, researchers have “reported an 89 percent drop in sudden cardiac deaths among athletes” (American, 2015).  That is a significant decrease in SCD.  Imagine if heart screenings were mandated in the U.S. with the same results.  Then, instead of 66 deaths from SCD each year, there would only be 7 or 8 each year.  Implementing mandatory heart screenings could save over 50 lives a year.  Italy’s mandatory heart screening process requires athletes to undergo an “ECG-based pre-participation physical examination (history and physical plus ECG in all athletes)” (Lawless, 2012).  This suggests that implementing something similar in the U.S. will save lives.  Heart screenings, if mandated in the United States, could save 58 lives each year by preventing sudden cardiac death.

Conducting heart screenings in student-athletes all across the country will save countless lives.  An echocardiogram, electrocardiogram, or 14-question checklist can evaluate the function of the athlete’s heart.  If something during the screening is abnormal and brings up concerns, then the athlete will be sent to receive more tests.  If the condition is confirmed, then the athlete’s participation in sports will need to be tailored to prevent sudden cardiac death.  Heart screenings will prevent sudden cardiac death and save lives. Universal heart screening can literally make the difference between life or death.

References

American Heart Association News. (2015). Screening Young Athletes For Heart Disease. Retrieved from American Heart Association website: https://news.heart.org/screening-young-athletes-for-heart-disease/

Heart Screening for High School Athletes: Should all high school athletes undergo heart screening? (2010). Retrieved from Issues and Controversies database.

Lawless, C. E. (n.d.). Cardiac Screening In Young Athletes: Why All The Fuss? In Science in Context. Retrieved from Gale database. (Original work published 2012)

Sudden Cardiac Arrest. (n.d.). Retrieved from Texas Heart Insitiute website: https://www.texasheart.org/heart-health/heart-information-center/topics/sudden-cardiac-arrest/

Young Athletes & Sudden Cardiac Arrest (SCA). (2018). Retrieved from Close the Gap: Health Equality for Life website: http://www.your-heart-health.com/en-US/heart-disease-facts/young-athletes.html

 

About Chelsea Gravereaux

I just finished my junior year at Emmaus High School in Emmaus, PA.  I started swimming summer league when I was 10 and then started swimming year-round for Emmaus Aquatic Club (EMAC) when I was 11 because I loved the sport.  Now, I swim for my high school as well and currently hold team records in 100 butterfly and 100 freestyle.  I have competed at PIAA States for the past 3 years in relays and individual events.

5
Leave a Reply

4 Comment threads
1 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
5 Comment authors
newest oldest most voted
SportsMedDoc

The American College of Sports Medicine and the American College of Cardiology have guidelines for what components are part of preparticipation physical exam. Hypertrophic cardiomyopathy is a common cause of sudden death in athletes and is the disease that is being screened for with 12 lead EKGs and echocardiogram. This condition is inherited in an autosomal dominant fashion and the prevalance of the disease is MUCH higher in Mediterranean area, especially Italy, which is why that country has adopted screening guidelines that are useful for the population there. Also keep in mind that although this is a genetic disease, the appearance of a thick heart wall is often not apparent until the person is in their early twenties meaning that,… Read more »

Coach

I had a high school swimmer who has hypertrophic cardiomyopathy. We found out during a main set, where it appeared he was having an asthma attack. When I pulled him out of the water, his hands and feet turned blue and purple. His heart rate and oxygen level bounced all over the place (I had an Oximeter). It was later that we found out he had a heart attack. He was one of the lucky ones. He is now a senior but can no longer compete in any sports. My heart breaks for him as he was fast enough to swim for a DIV II or III school…..

swimmer

A subject that can be overlooked until something serious happens to someone you know. Many symptoms of a larger issue, such as HCM, are missed during the simple physical screening process, therefore heart screenings for athletes are very important. Specifically for those who have a family history of heart conditions. I know there are foundations that put on heart screenings every year (Nick of Time Foundation, David Heller Foundation, etc) and they perform ECG, look at family history and get cardiologist clearance or reference for follow-up on-site and at a low cost. Thanks for the article!

Anonymous

Out of respect, I will write this without reference to place, time and names. I hope my personal situation helps. Many years ago, a young teen I was coaching had this exact type of episode in the early part of practice. We had finished warm up. The it happend. It was very sudden onset. There was zero warning. The swimmer pushed off on their first repeat the first set, went 15 meters before they passed out. My assistant coach in the water within seconds. We had the swimmer out of the water within maybe 30 to 40 seconds. At first, I thought maybe it was a seizure or something along those lines, but as soon I began the an assessment… Read more »

Don't want to miss anything?

Subscribe to our newsletter and receive our latest updates!