Screening athletes for cardiac defects

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According to an article in the NY Times “a young athlete dies from a cardiac incident once every three days in the United States” (Hidden Threats to Young Athletes – May 11, 2013). Sudden cardiac arrest is the number one killer of young athletes and is typically brought on by a pre-existing, detectable condition that could have been treated. According to nearly 360,000 sudden cardiac arrests occur outside of hospitals each year in the United States alone.

How could Sensi be used in pre-participation screening?

One of the key clinical findings to evaluate when screening athletes for cardiac defects are murmurs, to detect structural defects within the heart.

The American College of Preventive Medicine (ACPM) supports an evaluation prior to participating in high school and college sports using a history and physical assessment as developed by the American Heart Association[1]. This assessment includes 12 criteria for pre-participation cardiovascular screening of competitive athletes:

Personal History

  1. External chest pain/discomfort 
  2. Unexplained syncope / near-syncope 
  3. Excessive exertional and unexplained dyspnea/fatigue, associated with exercise 
  4. Prior recognition of a heart murmur 
  5. Elevated systemic blood pressure 

Family History

  1. Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in ≥1 relative. 
  2. Disability from heart disease in a close relative aged <50 years 
  3. 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

Physical Examination

  1. Heart murmur
  2. Femoral pulses to exclude aortic coarctation. 
  3. Physical stigmata of Marfan syndrome. 
  4. Brachial artery blood pressure (sitting position). 

Auscultation should be performed in both supine and standing positions (or with Valsalva maneuver), specifically to identify murmurs of dynamic left ventricular outflow tract obstruction.

Sensi is optimized to evaluate and classify cardiac murmurs as either pathological or innocent, to identify structural defects within the heart. The additional information provided by Sensi will also assist the physical examiner in identifying the type of murmur (early-, mid-, late-systolic or diastolic). Sensi will also allow you to keep record of the athlete’s heart sound and the auscultation findings.

  1. Maron BJ, Thompson PD, Ackerman MJ, et al. Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. Circulation 2007; 115 (12): 1643–55
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