Guest Post: Dr. Maria C. Yates on SCD
In honor of Congenital Heard Disease Awareness month, we have a special post from Dr. Maria C. Yates, MD, MS, a pediatric cardiologist practicing in the Houston area.
February is Congenital Heart Disease Awareness month in support of all of the children, adults, and their families who live with CHD every day. Approximately 1% of all infants born in the United States will have a congenital heart defect. Of these, about 25% will have a major heart defect. That means that approximately 10,000 children each year require some form of heart surgery prior to their first birthday (source: CDC). It is the job of a pediatric cardiologist to diagnose and manage these children.
While many children seen in a pediatric cardiology practice do have some form of CHD, many will have an evaluation which reveals a normal, healthy heart. Very common reasons for referral include heart murmurs, chest pain, palpitations, or syncope (fainting). Regardless of the reason for referral or the age of the patient, however, a very common concern of parents is that their child not be “that child” that dies suddenly during athletics.
While it may seem that the news reports are frequent, the fact is that sudden cardiac death (SCD) in athletes is a rare event. While different studies quote different statistics, overall the instance is probably somewhere around 1 event for every 160,000 athletes. Even though this is a low risk, athletes in the United States undergo yearly screening, although there is no uniform screening process in the United States. Current studies show that the most common cause of SCD in athletes is a condition called hypertrophic cardiomyopathy, where the walls of the heart are abnormally thick. Other causes include myocarditis (an inflammation of the heart muscle), abnormal coronary arteries, an inherited risk for rupture of a major artery (Marfan syndrome), or an inherited risk to develop an abnormal heart rhythm.
A particular athlete’s risk for sudden cardiac death depends on several factors. These include gender (males are at a much higher risk), ethnicity (African Americans are at a higher risk than Caucasians), and the athlete’s personal and family medical histories. The sport being played can also determine the level of risk, which is why in some athletes they can be cleared for some sports but not others.
Screening includes obtaining a detailed medical history of the patient and of the family, as well as a thorough physical exam. The American Heart Association has detailed the important items which should be evaluated in the history and physical exam. Does the athlete have chest pain with exertion, unexplained fainting, get tired easily with activity, have any history of heart problems, or have high blood pressure? Has anyone in the family ever had major heart disease or died suddenly under age 50, or does anyone in the family have a cardiomyopathy, Marfan syndrome, or inherited abnormal heart rhythms? On physical exam, does the athlete have a heart murmur, poor pulses in the arms or legs, have signs concerning of Marfan syndrome, or have high blood pressure? If so, then a more comprehensive cardiac evaluation is needed. The American Heart Association does not require an electrocardiogram (ECG) to be done on every athlete, however this is done in some school districts. An ECG can help to detect some, but not all, of the above conditions.
So, what can you do as a parent? Many schools or sports organizations will hand the athletes a questionnaire asking many of these questions. Go over the questionnaire with your child so that the examiner has the most accurate information. Secondly, encourage the athlete to be honest. Denying some concerning symptoms in order to get clearance only puts the athlete at risk. Many times, symptoms such as chest pain are determined to not be cardiac related at all, and the athlete can still be cleared after further evaluation. Thirdly, be sure that your child gets yearly checkups with their primary care physician. Conditions such as high blood pressure can develop at any time, and the earlier it’s discovered, the earlier it can be treated. Finally, be sure to get a sports physical early. That way, if something does come up that requires further evaluation, there’s time to get that done and your child will be able to start sports practice with the rest of the team. The closer to the start of the school year the physical gets done, the busier the clinics are.
For all athletes who do participate, there are a few things to keep in mind to keep them healthy. Firstly, athletes require more water intake than a person who isn’t as active. Athletes should drink plenty of water, at least 64 ounces per day. They should also take extra care to hydrate well the day prior to competition. Athletes should also drink frequently during games or practice, especially during the hot Texas summer. Extreme dehydration during activity can lead to heat-related illnesses. Heat related illness can range from a mild illness, to fainting, and in its most extreme form, can be life-threatening. Finally, an athlete should never attend practice or play sports if they have a fever. Fever increases the body’s metabolic demand, can increase the risk for heat related illness, and in rare situations, can be a sign of carditis. An athlete should not participate in activity until the fever has been gone for at least 48-72 hours without the use medications. When returning to play after an illness, they should gradually get back into physical activity instead of playing at full capacity right away.
Finally, it is important to remember that even the most thorough screening program will not catch all athletes at risk. However, the more information we have, the better we can assess your child’s risk. It is also important to remember that no examiner wants to restrict an athlete. If we do, we only have your child’s safety and health in mind. Many athletes initially restricted can eventually be cleared after further evaluation. In the rare case that your child is found have a heart condition, then we can make a plan to keep him or her as healthy as possible.
About the author:
Maria Yates grew up in Southwest Louisiana. She attended college at McNeese State University, graduate school at Tulane University in New Orleans, and medical school at Louisiana State University Health Sciences Center in New Orleans. She completed her residency and pediatric cardiology fellowship at the University of Texas Health Sciences Center at Houston. Her hobbies include photography and traveling.