Heart Health Screening in Children and Young People Before Participation in Sports
Sports are an important condition for individuals to be fit and are also a source of entertainment for children and young people. However, sudden cardiac deaths seen in children and young people who do sports create an important agenda in the press and encourage health institutions to take precautions in this regard. Heart health screening before participating in sports aims to reveal hidden heart diseases that do not show symptoms.
Athlete Heart Screening and Current Status
Most findings in those who do sports are actually considered normal. Rarely, life-threatening heart problems are encountered. For this reason, athlete heart scans aim to reveal insidious heart diseases that can cause sudden cardiac death.
So how should the screening be done? Are medical history and physical examination, including personal and family history, sufficient for screening? This problem has always been discussed and the results of the studies have been taken into account. But there is still no consensus in America and Europe on how to do it.
In studies where athletes who developed sudden death were investigated retrospectively, it was found that most of them had previously undergone a heart scan consisting of history taking and physical examination and had been approved for sports. has been made. For this reason, especially European health authorities have included ECG in the routine of athlete screening. This practice alone has reduced the risk of sudden cardiac death in children and young people who do sports. Thanks to these scans, genetic heart muscle diseases and rhythm disorders are detected early in children and young people. Early diagnosis allows these individuals to live longer with preventive treatment.
How is Athlete Heart Screening Performed?
First, medical history and physical examination are performed, and then diagnostic tests are performed step by step. ECG must be included in the first step of the tests. In recent years, the sports federation in our country has started to require at least one pediatric cardiology examination for children and young people who will participate in competitive sports and receive licenses. Echocardiography is almost always performed on all children who are examined by a pediatric cardiologist.
1. History on Heart Scan
In screening, both the athlete's personal medical history and family history are important considerations. Diseases that cause sudden cardiac death in athletes are mostly hereditary, meaning they are genetically transmitted. These include hypertrophic cardiomyopathy, which is a major heart muscle disease, and rhythm disorders such as long QT syndrome. It is also questioned whether there are relatives with coronary disease under the age of 50 in the family history. In the personal history, chest pain, darkening in the eyes, fainting, palpitations, premature fatigue and shortness of breath while doing sports are questioned. Current athlete license examination forms include questions regarding personal and family medical history, and the form is required to be filled out and approved by the child's family.
2. Examination in Heart Scanning
The most common finding encountered by the doctor during the physical examination is the hearing of a heart murmur. Murmur may be the first sign of asymptomatic but narrowing hypertrophic cardiomyopathy, aortic valve stenosis, and aortic coarctation. Some congenital heart diseases, such as atrial septal defect, have a very insidious course and can be diagnosed in adulthood. Thanks to this screening, the probability of diagnosis of such diseases in childhood increases. Murmur may also be the only symptom of valve diseases due to acute rheumatic fever, which has very silent clinical findings. Hypertension may also be detected incidentally during this screening.
3. Diagnostic Tests in Heart Screening
Since the aim is to reveal the diseases that cause sudden cardiac death, electrocardiography (ECG) and echocardiography (ECHO) must be included in the athlete's heart health screening plan as diagnostic tests.
- ECG
It is the evaluation of the electrical activity of our heart thanks to electrodes attached to the hands, feet and chest wall. Records are often transferred to paper. It is mostly used in adults to evaluate heart muscle damage due to coronary disease. However, ECG has a wide range of uses in both children and adults. These reasons make it very useful in the evaluation of adult and pediatric patients for the evaluation of congenital and acquired heart diseases. is. Hypertrophic cardiomyopathy, which is a disease that causes thickening of the heart muscle and is the most common cause of sudden cardiac death both in our country and in the world, can often be detected on ECG, even if it does not cause symptoms. In addition, rhythm disorders such as Long QT syndrome and Brugada, which are rare diseases, can only be detected on ECG.
- ECHO
In echocardiography, the anatomy and functions of the heart can be monitored instantly on the screen. . Diseases that affect the size of the heart muscle such as thickening or thinning of the heart muscle, congenital heart diseases such as ASD with vague symptoms, and rheumatic valve diseases can be detected with echo during this athlete's heart scan. In hypertrophic cardiomyopathy, the disease may occur after adolescence. If there is a family member with hypertrophic cardiomyopathy, annual echocardiography should be performed until adulthood.
- Advanced Diagnostic Tests
This group of tests are tests that are not included in the first step for athlete's heart screening, but These are the tests planned as a result of the evaluation of the screening results. Holter ECG and exercise ECG examinations may be requested in those who have palpitations during exercise or premature beats are detected on the ECG. Or, when heart muscle disease is suspected on ECHO, the heart muscle can be evaluated in more detail with cardiac MRI.
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