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A heart screening before competing?

Some pre-participating cardiac tests aren’t needed for all young athletes, specialists say.

if you have a son or daught er active in sports, you’ve probably heard the marketing and promotion of electrocardiogram (EKG) and echocardiogram testing for all young athletes before they participate in school or spare-time sports. Advertisers point to a tragic phenomenon known as sudden cardiac death (SCD), which claims the lives of a very few U.S. child and adolescent sports participants each year.

No one disputes the worthy goal of protecting kids. But not all young athletes really need pre-participation cardiac testing, says Michael Gewitz, M.D., Physician-in- Chief at Westchester Medical Center’s Maria Fareri Children’s Hospital and its Chief of Pediatric Cardiology.

For youngsters with no known risk factors, such detailed testing, which is not inexpensive, may cause more harm than it uncovers, says Dr. Gewitz. “This screening is not perfect,” he explains. “There are a host of cardiac problems these tests do not pick up. On the other hand, the tests can be overly sensitive and produce a lot of false-positive findings. Such inaccurate results can create unnecessary anxiety for parents and children and may lead to inappropriate restrictions.” For almost all kids, regular vigorous exercise is one of the keys to a healthy cardiac future.

So which young athletes should be given an EKG or echocardiogram to assess their heart risk before they take the field? Specifically, those with a known risk of or predisposition toward heart problems, says Dr. Gewitz. (See “Key Things to Check in Sports Physicals,” below.)

“Any family history of sudden cardiac arrest is one red flag,” says Dr. Gewitz. And Christa Miliaresis, M.D., a pediatric cardiology exercise specialist at Maria Fareri Children’s Hospital, agrees. “In a physical, a doctor must ask if the child ever passed out or fainted during sports,” she says. If either of these questions draws a yes, EKG and/or echocardiogram testing can be an important next step to evaluate the danger and guide appropriate parental decisions.

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