Every time an athlete, who seems to be in the peak of physical health, dies suddenly during competition because of an unknown heart defect, the public turns its attention to physicians and researchers for answers in how to prevent such tragedies.
But the answers aren't so simple. The ongoing debate within the medical community over how best to screen young athletes for heart defects that could lead to sudden death took another turn today with the publication in the journal Circulation (subscription required) of new recommendations on how to interpret the electrocardiogram results of the extremely fit.
Most of the ongoing debate centers around whether ECGs should be mandated as screening tests prior to sports participation, with some countries in Europe saying "Yes" and the United States saying "No," citing high costs and difficulty interpreting ECG results accurately. A recent Stanford study found that even highly trained pediatric cardiologists are prone to misinterpreting these results.
The goal of the Stanford team, who worked with cardiology experts worldwide to develop this how-to guide for physicians, is to reduce the high percentage of false positives in heart screenings for athletes, which can led to unnecessary and expensive followup tests and emotional trauma.
The press release I wrote about the new recommendations discusses why they are needed: Athletes' ECGs are often dramatically different from those of people with more sedentary lifestyles and don't follow the same set of rules of interpretation. What may be interpreted as a heart attack in your average couch potato may be a perfectly normal ECG in an athlete.
"Currently there are no clear-cut guidelines for reading ECGs for athletes," said Victor Froelicher, MD, a Stanford professor of cardiovascular medicine and one of two senior authors of the paper. He has been interpreting the ECG results of athletes going back 20 years in his work with astronauts and military pilots. "This recommendation paper we've put together reflects years of experience and helps to provide a consensus among experts worldwide."
The recommendations are also designed to help practitioners determine what follow-up tests they need to do when they determine an ECG reading is abnormal.