AHA’S 14 STEPS FOR ATHLETIC PHYSICALS
The American Heart Association’s (AHA’s) 14-Element Rec- ommendations for Preparticipation Cardiovascular Screening of Competitive Athletes include:
Personal history 1. Chest pain/discomfort/tightness/pressure related to exertion
2. Unexplained syncope/near-syncope 3. Excessive and unexplained dyspnea/fatigue or palpitations associated with exercise
4. Prior recognition of a heart murmur 5. Elevated systemic blood pressure 6. Prior restriction from participation in sports 7. Prior testing for the heart ordered by a physician
Family history 8. Premature death (sudden and unexpected, or otherwise) before age 50 attributable to heart disease in one or more relatives
9. Disability from heart disease in close relative younger than 50
10. Hypertrophic or dilated cardiomyopathy, long-QT syn- drome, or other ion channelopathies, Marfan syndrome, or clinically significant arrhythmias; specific knowledge of genetic cardiac conditions in family members
Physical examination 11. Heart murmur 12. Femoral pulses to exclude aortic coarctation 13. Physical stigmata of Marfan syndrome
14.Brachial artery blood pressure (sitting position)
Source: Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age): A Scientific Statement From the American Heart As- sociation and the American College of Cardiology
gist Arnold Fenrich, MD, a member of UIL’s Medical Advisory Committee, testified against HB 767 on his own behalf before the House of Represen- tatives, he called the bill’s failure “sort of bittersweet” because he felt bad for its advocates who genuinely believed that mandatory EKG screenings could save many lives. “I don’t think it should’ve passed,
but I know there were a lot of people who really felt strongly about it,” he said. “If I could reach out to them, I’d say that I really am sorry. I didn’t want this not to pass to cause anybody any hard feelings or for anybody to be sad about it. But I think that if you look at all the data, this isn’t the direction and route that we should be going.”
THE EVIDENCE In a 2012 policy statement, which didn’t support large-scale prescreen- ing with EKGs, the American Acad- emy of Pediatrics noted a Centers for Disease Control and Prevention esti- mate that about 2,000 patients young- er than age 25 die of sudden cardiac arrest each year. The statement listed three categories of causes predispos- ing young people to SCA: structural or functional causes, such as hyper- trophic cardiomyopathy; electrical causes, such as the heart rhythm dis- order known as long QT syndrome; and other causes, such as the use of illicit drugs or primary pulmonary hypertension. The UIL Medical Advisory Com-
mittee, which develops guidelines for sports and certain competitive activities in Texas public high schools, recommended in 2006 that each UIL- member high school campus carry at least one automated external defibril- lator (AED). The Texas Legislature subsequently passed that requirement into law, which took effect immediate- ly when Gov. Rick Perry signed it on June 15, 2007. On Aug. 1 of the same year, a UIL rule requiring one AED per campus took effect. Dr. Fenrich says advocates of screening athletes with EKGs and
50 TEXAS MEDICINE July 2015
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