Prospective Screening of 5615 High School Athletes for Sudden Cardiac Death

Screening for common causes (hypertrophic cardiomyopathy and anomalous coronary artery) of sudden cardiac death (SCD) in high school athletes (HSA) during pre-participation exams is varied and relatively unstudied. Efforts to improve diagnoses of potentially serious or lethal congenital heart conditions are needed. We prospectively evaluated HS at 34 different high schools over three years. Cardiovascular screening included obtaining history of angin or anginal equivalents, or family history of SCD before age 35 years. 12-lead EKG and cardiovascular physical exam were performed. Abnormalities resulted in cardiac ultrasound (CU). Abnormal EKG for LVH was defined in boys as SV1 and RV5 > 50 mm and in girls as SV1 plus RV5 > 40 mm. Follow-up of cardiovascular abnormalities followed 16th Bethesd Conference Guidelines. Results: 5,615 HS (3378 boys, 2237 girls) were evaluated. 115 (2%) had abnormal cardiovascular history, 196 (3.5%) had abnormal cardiovascular exam, 193 (3.5%) had abnormal EKG and 126 (2%) had combined abnormalities. All 630 (11%) with abnormal cardiovascular screening underwent CU at the time of their exam. 43 HS (7% of CU performed) were found to have minor abnormalities. No serious previously undetected abnormality was noted with CU. No LVH was seen in 28 HS with LVH by ECG. 5140 (91.5%) HS were approved for competitive sports; 435 (7.8%) HS were approved for competitive sports after follow-up by local M.D. (recommended primarily for evaluation of mild hypertension); 40 (0.7%) HS were not approved due to anginal symptoms (n = 16) requiring subsequent treadmill testing (all of which were normal); systolic BP > 170 or diastolic BP > 110 (n = 5), carotid bruit (n = 2), severe Al by exam (n = 1), WPW (n = 6), PVCʹs (n = 5), RBBB (n = 4), SVT (n = 1). EKG alone led to disqualification in 16 or HS undergoing screening. No cases of hypertrophic cardiomyopathy or anomalous coronary artery were detected prospectively. One SCD occurred in an approved HS due to anomalous coronary artery. Conclusions: Common causes of SCD in HS are rare and/or methods to detect them are insensitive; serious CU abnormalities in this population are rare; EKG added to the cardiovascular history and physical exam increases the ability to detect potentially serious abnormalities necessitating further cardiovascular testing before approval for competitive sports.