Keeping Your Children Safe From Sudden Death?
A recent story about a 17-year-old Boy Scout who died suddenly during a 7.7-mile hike in Florida has everyone wondering what went wrong. Every time I see a story like this, where an unexplained death occurs in a young person – especially an otherwise healthy teenage athlete – it makes me wonder whether it’s a good idea to have in-depth annual physicals performed on adolescents contemplating participating in high-endurance sports.
Most children get an annual physical as required by state law to attend school or play sports. I have three children, and for the most part, their physicals constitute a review of systems, blood pressure, weight and height documentation, vital signs and maintenance of vaccination schedules.
So the question is: Should adolescents have more in-depth assessments done to evaluate the status of their cardiovascular health?
This of course is a controversial question to ask because doctors can’t seem to agree on what tests should be done. And with the swelling numbers of uninsured Americans and the escalating costs of preventive medicine not covered by insurers, we’re immediately challenged with the dilemma of who’s going to pay for cardiac testing, and what happens if we do find something wrong?
A perfect example of this is the current criticism of prostate cancer screening. Many studies are now suggesting that these screenings may lead to unnecessary procedures and negative side effects — that ultimately are ineffective in changing the course of the disease.
Now I can understand evaluating the effectiveness of prostate cancer screening versus cost and quality of life issues – especially because of the nature of the disease and the age group that it typically affects.
But when it comes certain heart diseases in the adolescent patient population, we’re not looking at quality of life issues – but often, the difference between a life saved and a life lost.
One condition in particular that I think that teenagers should be screened for, is hypertrophic cardiomyopathy (HCM). This is a genetic condition that affects one out of 500 people and is the leading cause of heart-related sudden death in people under 30. And unfortunately, if it goes undetected, most parents only find out about HCM after their child dies on the field or court.
Hypertrophic cardiomyopathy is a condition in which the heart muscle becomes abnormally thick, making it harder for the heart to pump blood and sometimes interfering with its electrical rhythms. HCM tends to run in families, and children of parents with the genetic mutation for the disease have a 50 percent chance of inheriting it.
The reason HCM often goes undiagnosed, is because it rarely presents any noticeable symptoms. And while it can lead to severe cardiac problems at any age, but I would argue that if the condition is identified in the teenage population, proper monitoring could lead to a decrease in sudden, unexpected death among athletes.
Many states are looking into mandatory cardiovascular assessment of young athletes in an effort to identify patients at risk. Still cardiologists are not sure what the best method of screening should be — whether routine electrocardiography or echocardiograms prior to the start of the sports season would provide the most cost-effective, comprehensive data to aid in identifying athletes at risk.
I know that this debate will go on for quite a while, but I think that any parent with a teen or child participating in sports should have a conversation with their pediatrician.
Tags: teens, cardiovascular health, blood pressure, heart, Dr. Manny Alvarez, heart disease, genetic mutation, Insurance, sports, hypertrophic cardiomyopathy, adolescent population, arrhythmia, HCM, quality of life, athletes, physicals, vitals, assessments, sudden death, cost, heart muscle, prostate cancer screening, cardiologists, electrocardiography, echocardiograms
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Dr. Alvarez-
I think you aree hitting on a very important topic. While it is important to note that we see athletes die of HCM regularly (even olympic athletes who see many doctors) it should also be noted that the majority of HCM deaths occur while the victim is sedentary.
The athletes that do die of HCM almost invariably were evaluated by a doctor in order to play whetever sport they were engaged in. That means it was missed, and I think that is a serious problem. If they are being evaluated for their suitability to engage in sport one would think they should be evaluated for that which might kill them.
Beyond that, as you said, the incidence is 1 in 500, but the number that might have more impact is the 3500 or so deaths per year, and as I related most of them die while sedentary and not engaged in sport. We do need to do something regarding the evaluation of athletes in this regard but what about the rest?
I read a case recently in the news about a child who died of a “heart defect” that had been misdiagnosed and treated for GERD. I think you know as well as I do that it was HCM that killed him. A child that presents with such signs and symptoms most certainly needs to be evaluated for HCM.
An “in depth physical” need not be the answer and perhaps a more focused physical would be in order since we know quite well what we are looking for. If there is any doubt, an echo is simple, non-invasive, and painless.
Regards
FM Chaves MD
I am a friend of the family of the scout who passed away in the Big Cypress Swamp on Saturday. It is a tragedy that no one understands. The hike was a 20 miles, not 7.7 as erroneously reported, on an extremely difficult trail on a very hot Florida day. The Scout had a checkup the month prior to the hike. The scout also had turned in the Class Three medical form required by the Boy Scouts; the form was signed by both the boy’s doctor and the parents. There was no medical condition noted and the parents are unaware of any medical condition. I don’t know why the Sherrif’s office made the assumption that there was a medical condition involved. Maybe, but maybe it was heat stroke too.
While there is no way to prevent one hundred percent of these tragic deaths, all schools should employ at least one certified athletic trainer (ATC). These are the health care professionals who deal with sport-related injuries and disorders. How many young student-athletes have to die before school systems invest in certified athletic trainers?
i have three children that play sports for the school system. i believe that chidlren need to have a more indepth physical. especially for football. these children play in extreme conditions, in full gear and few water breaks. the standards need to be a little higher for the safety of our children
I know of one country, Algeria (there may be more), that requires the youth to get cardiograms and releases from a cardiologist before they are allowed to participate in soccer.
Maybe the same regulation should be used here in the US.
Each of these articles touches my heart as my 11 year old daughter became a victim of sudden cardiac arrest. Janet was a seemingly healthy child who was cleared for participation in activities after a standard physical. There were no warning signs. She collapsed while jogging a lap at cheerleading practice and was the picture of health her whole life – including the day of her SCA. It took two years for us to find out that she had a rare congenital defect called bilateral hyoplasia of the right and left circumflex coronary arteries. We believe in cardiac screenings, but we also believe that Automatic External Defibrillators (AEDs) should be in all schools and youth sporting events. We are currently advocating for Janet’s Law in NJ which would require this. Thank you for letting me comment.
Sincerely,
Karen Zilinski
have you heard of sjs/tens? What is expected as a child with tens grows up
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