Every sports fan knows the thrill of looking forward to a new season, as media coverage heralds the opening of training camp and results from scrimmages. Along with exciting preseason news, every sports fan has also read the sickening news of a promising young athlete unexpectedly dropping dead in the prime of his or her life. Often, the culprit is an undiagnosed heart condition. Since most sports programs require a physical examination to clear the athlete for sports, we ask: how did the heart condition escape the doctor’s exam?
The American Heart Association published guidelines for screening athletes for occult heart conditions in its journal called Circulation. The article, Recommendations and Considerations in Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update, recognizes that these tragedies are occurring with increasing frequency, particularly in basketball and football. The recommendations represent a consensus effort to prevent sudden cardiac arrest in athletes by identifying those athletes who are at risk and either fixing the problem or sidelining the athlete.
According to the article, most instances of sudden cardiac death are due to congenital abnormalities in young athletes. Not surprisingly, in older athletes, the most likely cause of unexpected heart attacks is undiagnosed coronary artery disease.
The guidelines recommend that a 12-point personal and family history be obtained to identify higher-risk individuals. If any one of the 12-point inventory is affirmed, then the patient should be referred for a thorough cardiovascular evaluation before eligibility can be established. Unfortunately, the guidelines do not adopt a European recommendation that athletes undergo an electrocardiogram (aka ECG or EKG) as part of routine screening for medical clearance.
Under Ohio law, generally speaking, physicians are required to perform preparticipation physical exams in a manner consistent with how other physicians in same or similar circumstances perform such exams. Malpractice attorneys argue that failure to follow published guidelines constitutes medical malpractice. Likewise, the AHA guidelines recognize that “the law generally requires that physicians use reasonable care in detecting foreseeable medical abnormalities that may cause sudden death ….”
