EKGs for Athletic Kids: Protecting the Young at Heart
Not yet the norm, EKGs could become commonplace as computers learn to interpret results.
Brenda Gergich had open heart surgery at Newark Beth Israel Medical Center in February to repair a congenital heart defect. Last Saturday she was back with her entire family, and the three children had electrocardiograms during the free sports physical clinic the hospital runs twice a year to identify heart abnormalities, and screen student athletes for concussions.
Most kids don’t get an EKG before going out for sports, and a state task force on sudden cardiac death in athletes recommended doing a better job on the sports physical. The new legislation requires cardiac examination training for the clinicians who perform them, but it stopped short of recommending EKGs.
State Sen. Fred Madden (D-Gloucester, Camden) has introduced several bills in Trenton to implement the task force recommendations. But while universal EKGs are not yet a standard procedure in New Jersey or the nation, some experts predict that could become the norm in a few years as technology evolves to enable EKGs to be analyzed accurately by computers.
The screenings were offered by the Mathew J. Morahan III Memorial Health Assessment Center for Athletes, which, like Newark Beth Israel is part of Barnabas Health and is based at the Barnabas Ambulatory Care Center in Livingston.
The center was founded by the family of Matthew J. Morahan, who died suddenly in 2009 at age 30, and since 2010 it has done EKGs on about 1,500 children and teenagers. None of the 42 youngsters screened last Saturday had a serious enough heart problem to disqualify them from sports, according to Dr. Rajiv Verma, director of the children’s heart center at the Children’s Hospital of New Jersey at Newark Beth Israel. But when the hospital offered the same program this past November, an EKG identified a 15-year-old with an abnormally thickened heart wall.
“Unfortunately we had to restrict him. He is not allowed to play football,” Verma said. “It is always a struggle. I try to educate teenagers that our aim is not to restrict them from playing sports; our aim is to have them participate in sports in a safe manner.”
That youngster can still jog, run, swim, and play baseball: but football is out. “They do so much weight lifting,” Verma said. “If a child does 10 pushups a day that is not a big deal, but these young men do 50 to 100 pushups a day, which is basically lifting your own weight, and that is just not acceptable.”
At age 14, Joshua Gergich is nearly six foot tall and a freshman who plays football at Roselle Park High School. Before he went in for his physical, he was worried that the doctors would find a heart abnormality that would end his football career. “I’ve been playing football my whole life,” he said. The test revealed no cardiac problems: “I feel good that I don’t have anything wrong with me.”
Dr. Stephen Rice, president of the New Jersey chapter of the American Academy of Pediatrics and a specialist in sports medicine, chaired the task force that recommended improving the sports physical in order to do a better job of identifying children who are risk of sudden cardiac death. Right now there are not enough clinicians trained to interpret a pediatric EKG, Rice said. But he said the technology is evolving, and in a few years it may be possible to accurately interpret the EKG with software. “We may be able to make a determination of normal or abnormal through the electronics, rather than have someone reading it. That is the world that we are advancing toward. It may be several years before we are in a place where we can think that universal screening is a relevant and appropriate thing to do. I don’t think we are quite ready to say that. But this is an area that a lot of attention is focused on, and we are moving toward solutions. And there are plenty of people who want to push that envelope.”
Among them is Verma, who said “there is absolutely no doubt in my mind” that every child should have an EKG before playing competitive sports. “You can pick up abnormalities that you would never suspect and that can trigger a lethal or fatal arrhythmia.”
Currently there is no national registry of sudden cardiac death in the young, and the nonprofit Parent Heart Watch is advocating the creation of a registry. Martha Lopez-Anderson, president, said estimates range from 200 a year to several thousand. “We are all speculating. We need a registry because we don’t know what the incidence rate is.” Advocates argue that there would be more willingness to screen all athletes via EKG if a complete registry of sudden cardiac death were to reveal, as they believe that it would, that the number of cases is underestimated.
Parent Heart Watch collects news reports on sudden cardiac death in the young, and posts them on its website, but she said press reports probably only capture about half the cases.
“Unless it is a high-profile case or it happens in a public place, we are not likely to know about it, Lopez-Anderson explained.The State Department of Health does not have statistics on sudden cardiac death in kids, but said these cases are quite rare. New Jersey last June became the first state in the nation to require hospitals to screen newborns for congenital heart defects before they leave the hospital, and in at least two cases, babies’ lives were saved.
Cardiovascular disease is among the leading causes of death for adults. In 2010, 18,794 adults in New Jersey were diagnosed in the hospital as having had a heart attack.