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Summer 2013 - What's an ECG Screening?

Does My Young Athlete Need One?

The heart is a muscle, and its rhythm is controlled by an electrical system. An electrocardiogram (ECG), which is a painless five-minute procedure, is a recording of the heart rate. The ECG and a questionnaire make up the first two steps of an ECG screening for cardiovascular health concerns for young athletes.

There is no blood draw, no electrical current and no radiation. “It basically is just an electronic snapshot of the heart’s activity – this gives us both quantitative (heart rhythm and heart rate) and qualitative information,” said Angelo Milazzo, MD, pediatric cardiologist and medical director of Duke Consultative Services. “We look at that and review a health risk questionnaire on-site the same day to determine if there is a need for step three, which includes an extended conversation with the family.”

“Thanks to a joint effort between WakeMed Heart Center’s Cardiovascular Testing Team and Dr. Milazzo, we have been able to offer free ECG screenings for more than 200 youth athletes,” said Dr. Mark Piehl, medical director of WakeMed Children’s.

Which Athletes Should be Screened?
According to Dr. Milazzo, there is no universal agreement on the age at which a child should be screened. “From my perspective, I would not screen children unless they are participating in a competitive or traveling sport with practice more than once a week or competitions that may not allow youth to take themselves out of the game,” said Dr. Milazzo. “It is important to look at the level of competition more than the sport – think beyond team sports to include cycling, running, gymnastics, dance, archery and others.”

If a parent is interested in a screening for their child, they should talk with their pediatrician or family physician about medical history to determine if there is a need for further investigation. Dr. Milazzo also recommends getting a blood pressure and cholesterol screening. These can serve as a baseline for future.

Families should be sure to track and review the medical history of children, parents and grandparents regularly. Share this information with your child’s care providers and keep them informed with any new information. This will help your provider guide you to a test if it is appropriate.

Are Screenings Required?
“I am not aware of any school districts in the country that are making it mandatory, but there are a lot of grassroots and community screenings,” said Dr. Milazzo. “The Italians were the first to institute a nationwide screening – all high school athletes are screened in Italy, but this has not been possible in the U.S. due to the population magnitude.”

What Could You Find?
“We aren’t looking for one disease,” said Dr. Milazzo. “We are looking for a cluster of things that are all rare and have different manifestations.” Hypertrophic cardiomyopathy is one that has been frequently covered by the media because many young athletes die suddenly from this, but screenings look for a lot more. An ECG can also detect a long QT syndrome and Wolff-Parkinson-White, both of which can be life threatening. “Fortunately, I’ve only found one of these in recent screenings of young athletes,” said Dr. Milazzo.

Approximately 215 youth athletes have taken advantage of free ECG screening events offered in the past year by WakeMed. Two cardiovascular health problems have been discovered during those screenings.

Dr. Milazzo emphasizes that screenings are not perfect. You never completely rule out that something can happen. “We are casting a wide net but looking for a tiny fish in a big ocean,” said Dr. Milazzo. “There is no perfect tool.”

“The questions we are asking are just as important, if not more than, the ECG,” said Dr. Milazzo. “Some risk factors are simply not apparent to a family, but a combination of information can raise our eyebrows at a screening.” The multi-layered approach of an ECG along with a questionnaire can reveal things that are worth looking into and may justify certain precautions in the future.

“There is value and power in the knowledge to have things regularly checked,” said Dr. Milazzo.

Cause for Alarm?
Families who live in communities where a young athlete has died should be careful about how they process information and react. “Thankfully, most kids are healthy even if they’ve never been screened,” said Dr. Milazzo. “The kinds of things that put youth at risk are few and far between, but it feels so immediate when it happens in your community.”

Kids should be encouraged to remain active unless good reason exists to slow things down a bit. “It is so critical to keep today’s youth moving to counter the easy distractions of video games and hours of screen time they log daily,” said Dr. Milazzo. “A big part of my job is to promote cardiovascular fitness!”

Dr. Milazzo’s Healthy Athlete Tips
Hydration is important
– Drink good old-fashioned water throughout the day.

Be mindful of potential symptoms – Contact a doctor if a child reports chest pain or shortness of breath. A child with pain at rest is less concerning than those while exercising. It is not normal to have chest pain when you are being active.

Healthy weight is key for athletes – Even though they are active, youth athletes can be overweight. Some think that bigger is better. They should be reminded that they can be strong, sturdy and competitive without being overweight. Wise food choices can help prevent future cardiovascular problems, diabetes, sleep apnea and more.


As published in Families First Magazine - Summer 2013


FF summer 2013 ECG 2




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