It’s very hard to look a 17-year-old high school football star in the eye and tell him that he needs open heart surgery. But it’s even harder to read stories about young people who have cardiac arrests at home, at school, and on the playing field – or who develop heart problems later in life. That’s why the team at my hospital started doing free heart screening tests for young people a few years ago. Since then, we have identified dozens of kids with heart issues who didn’t show any symptoms. Our program, Play Smart Youth Heart Screenings, is one of many in the nation offering this free preventive service. If you’re interested in having your child screened, here are the five things you need to know:
1. Sudden cardiac death in young people is infrequent, but it does happen. Any life lost is a tragedy, no matter how rare. A recent study found the rate of sudden death among NCAA athletes to be about 1 in 43,000, and as high as 1 in 3,000 in Division I male basketball players. We don’t have accurate data on high-school-age children. Cardiac arrest is typically caused by structural or electrical-system defects in the heart — ones that often have no symptoms until they cause a problem. Males appear affected much more than females, and African-American males may be at highest risk.
2. There is controversy as to who should be screened and how. Research increasingly shows that doctors spot more hidden heart issues by going beyond looking at symptoms or family history and doing more tests, such as an electrocardiogram (ECG) or echocardiogram (ultrasound of the heart). Critics argue that this strategy is too costly to be adopted nationwide. They also contend that spotting heart problems in young people still may not significantly reduce the rates of adolescent sudden death, which are already low. But many doctors and families believe that parents and kids should have the opportunity to decide for themselves, and that heart screening tests should be available to people who want them.
3. Heart screening tests are painless and quick. An ECG takes around 5 minutes to do. An echocardiogram takes about 30 minutes or less. Both are painless, noninvasive, and don’t expose anyone to radiation.
4. Screenings are increasingly available. Over 50 organizations nationwide provide heart screenings that are typically free or are available at a small charge. These screenings are typically sponsored by nonprofit foundations, universities, and health care systems. Go to www.screenacrossamerica.org to find screenings in your area or talk to your child’s doctor about other local opportunities. Testing can be expensive (hundreds or thousands of dollars) if you pursue it on your own, and screenings with electrocardiograms or echocardiograms are not currently covered by insurance in the absence of symptoms.
5. No screening test is perfect. While an electrocardiogram or echocardiogram is superior to the traditional history and physical exam for diagnosing heart disease in young people, no test can uncover all abnormalities. And unfortunately, some kids do have sudden cardiac arrest even with normal cardiac testing. Even though a normal cardiac screening test may be reassuring, there are sadly no guarantees for this or any type of medical testing. We do identify an abnormality in approximately 1 out of 100 kids that requires further evaluation.
Thanks to preventive screening, that 17-year-old patient of mine who needed open heart surgery a couple of years ago is back on the practice field this fall – he’s starting on his college football team as a sophomore this year. I’m glad to be part of his team.