青少年运动员心血管系统评估方法

Cardiovascular Evaluation in the Athlete
Richard Sterba, M.D., is a pediatric cardiologist at The Cleveland Clinic and coaches soccer.

Sudden death in a child, teenager or college-age athlete is a rare but newsworthy occurrence. When it happens, the question arises: Should schools have AEDs (automated external defibrillators) on site?

It is a question that only your high school can answer on a case by case basis. AEDs can save lives when cardiac arrest occurs. All coaches must be trained in CPR; if an AED is present, coaches must be trained on how to use it, and in determining when to use it as well. Each school must look at the cost and decide what is right for its community. John Carroll University has had an AED for 10 years, and it has been used once - on a quarterback's father who was watching in the stands. EMTs need to be called in when someone is in cardiac arrest whether or not there is an AED on site or not.

Regardless of whether your school can afford an AED or not, the best way to avoid sudden cardiac death in athletes is careful pre-participation history and physical examination. These should reveal which athletes may be at risk for sudden death. Young athletes with known cardiac abnormalities need to know the limitations on their degree of participation.

A young athlete's past, present and family history is the most important information for your physician to obtain and document. Past history of heart disease, murmurs and infectious diseases of the heart may lead to further testing. A history of palpitation or tachycardia especially associated with syncope will demand further testing prior to participation. Chest pain or shortness of break with exercise should further be evaluated. Family history of early sudden death, a thickened heart or Marfan syndrome warrant further testing.

The Ohio High School Athletic Association has created a new sports participation screening that will help better screen young athletes.

The physical examination will uncover most structural abnormalities. The routine use of electrocardiography and echocardiography in amateur athletes is probably not warranted. It has been found that if 200,000 athletes were screened, approximately 1,000 would have significant cardiovascular disease. Ten of these would have a potentially lethal condition, and one would die suddenly. The cost of those screenings for a typical high school would be ,000 a year.

A completely and correctly filled out medical history form and listening to the heart should identify patients who need further testing, and the new screening form from OHSAA should help.