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By Pamela Johnson

Reporter-Herald Staff Writer

Electrocardiogram (EKG) / Stress Test / Holter Monitor

What is an electrocardiogram?

An electrocardiogram (ECG or EKG), is a measurement of the electrical activity of the heart. By placing electrodes at specific locations on the body (chest, arms, and legs), a graphic representation, or tracing, of the electrical activity can be obtained. Changes in an ECG from the normal tracing can indicate one or more of several heart-related conditions. Disorders that are not associated with heart conditions may also cause changes in the ECG.

To better understand the ECG, it is helpful to understand the heart's electrical conduction system.

The Heart's electrical system

The heart is, in the simplest terms, a pump made up of muscle tissue. Like all pumps, the heart requires a source of energy and oxygen in order to function. The heart's pumping action is regulated by an electrical conduction system that coordinates the contraction of the various chambers of the heart.

How does the heart beat?

An electrical stimulus is generated by the sinus node (also called the sinoatrial node, or SA node), which is a small mass of specialized tissue located in the right atrium (right upper chamber) of the heart. The sinus node generates an electrical stimulus regularly (60 to 100 times per minute under normal conditions) and is sometimes referred to as the "pacemaker" of the heart. This electrical stimulus travels down through the conduction pathways (similar to the way electricity flows through power lines from the power plant to your house) and causes the heart's lower chambers to contract and pump out blood. The right and left atria (the two upper chambers of the heart) are stimulated first and contract a short period of time before the right and left ventricles (the two lower chambers of the heart). 

The electrical impulse travels from the sinus node to the atrioventricular node (also called AV node), where impulses are slowed down for a very short period, then continue down the conduction pathway via the bundle of His into the ventricles. The bundle of His divides into right and left pathways to provide electrical stimulation to the right and left ventricles.

Normally at rest, as the electrical impulse moves through the heart, the heart contracts about 60 to 100 times a minute. Each contraction of the ventricles represents one heartbeat. The atria contract a fraction of a second before the ventricles so their blood empties into the ventricles before the ventricles contract.

Almost all heart tissue, under certain conditions, is capable of starting a heartbeat, or becoming a pacemaker. The following are a few examples of those conditions:

• The heart's natural pacemaker develops an abnormal rate or rhythm

• The normal conduction pathway is interrupted

• Another part of the heart takes over as pacemaker

What does an ECG mean?

Almost everyone knows what a basic ECG tracing looks like. But what does it mean?

• The first little upward notch of the ECG tracing is called the "P wave." The P wave indicates that the atria (the two upper chambers of the heart) are electrically stimulated to pump blood to the ventricles.

• The next part of the tracing is a short downward section connected to a tall upward section. This next part is called the "QRS complex." This part indicates that the ventricles (the two lower chambers of the heart) are electrically stimulated to pump out blood.

• The next short flat segment is called the "ST segment." The ST segment indicates the amount of time from the end of the contraction of the ventricles to the beginning of the "T wave".

• The next upward curve is the T wave. The T wave indicates the recovery period of the ventricles after contraction.

When your physician studies your ECG, he or she looks at the size and length of each part of the ECG. Variations in size and length of the different parts of the tracing may be significant. The tracing for each lead of a 12-lead ECG will look different, but will have the same basic components as described above. Each lead of the 12-lead is "looking" at a specific part of the heart, so variations in a lead may indicate a problem with the part of the heart associated with the lead.

Why is an ECG done?

Many conditions can cause changes to the ECG. Because the ECG is a fast, simple, painless and relatively inexpensive test, it may be used as a part of an initial examination to help the physician narrow the scope of the diagnostic process. ECGs are also done with routine physical examinations so that comparisons can be made with previous ECGs to determine if a hidden or undetected condition might be causing changes in the ECG. Some conditions which may cause changes in the ECG pattern may include, but are not limited to, the following:

• Ischemia. Decreased flow of oxygenated blood to the heart due to obstruction in an artery.

• Heart attack. Also called myocardial infarction (MI); damage to the heart muscle due to insufficient blood supply.

• Conduction disorders. A dysfunction in the heart's electrical conduction system, which can make the heartbeat too fast, too slow, or at an uneven rate.

• Electrolyte disturbances. An imbalance in the level of electrolytes, or chemicals, in the blood, such as potassium, magnesium, or calcium.

• Pericarditis. An inflammation of the sac (thin covering) that surrounds the heart.

• Valvular heart disease. One or more of the heart's four valves can become defective, or may be congenitally malformed at birth.

• Enlarged heart. An abnormally large heart can be caused by various factors, such as valve disorders, high blood pressure, congestive heart failure, electrical disturbances, or congenital (present at birth) abnormalities.

• Chest trauma. Blunt trauma to the chest, such as a motorist hitting the steering wheel in an automobile accident.

This list is presented as an example. It is not intended to be a comprehensive list of all conditions which may cause changes in the ECG pattern.

An ECG may also be done for the following reasons:

• To obtain a baseline tracing of the heart's function (during a physical examination). This baseline tracing may be used later as a comparison with future ECGs, to see if any changes have occurred.

• As part of a work-up prior to a procedure such as surgery to make sure a heart condition does not exist that might cause complications during or after the procedure

• To check the function of an implanted pacemaker

• To check the effectiveness of certain heart medications

• To check the heart's status after an MI, or after a heart-related procedure such as a cardiac catheterization, heart surgery, electrophysiological studies, etc.

How is an ECG done?

An ECG is one of the simplest and fastest procedures used to evaluate the heart. An ECG technician, nurse, or physician typically will place 12 separate electrodes (small plastic patches) at specific locations on your chest, arms, and legs. The electrodes are self-sticking and will adhere to the skin. The area where the electrodes are placed may be cleaned, or hair may need to be shaved or clipped so there is a better connection. You will be lying down on a stretcher or bed, and the leads (wires) will be connected to the electrodes. You will need to lie very still and not talk during the ECG procedure, as movement or talking may interfere with the tracing. The technician, nurse, or physician will start the tracing, which will take just a few minutes. You will not feel anything during the tracing. Once a clear tracing has been obtained, the leads and electrodes will be removed, and you will be free to continue on with your usual activities, unless directed otherwise by your physician. An ECG can indicate the presence of arrhythmias (an abnormal rhythm of the heart), damage to the heart caused by ischemia (lack of oxygen to the heart muscle) or myocardial infarction (MI, or heart attack), a problem with one or more of the heart valves, or other types of heart conditions.

There are additional ECG procedures which are more involved than the basic ECG. These procedures include the following:

• Exercise ECG, or stress test. The patient is attached to the ECG machine as described above. However, rather than lying down, the patient exercises by walking on a treadmill or pedaling a stationary bicycle while the ECG is recorded. This test is done to assess changes in the ECG during stress such as exercise.

 

signal-averaged ECG. This procedure is done in the same manner as a resting ECG, except that the heart's electrical activity is recorded over a longer period of time, usually 15 to 20 minutes. Signal-averaged ECG is done when risk for arrhythmia is suspected, to detect subtle abnormalities in the ECG that are not visible to the naked eye. 

• Holter monitor. A Holter monitor is an ECG recording done over a period of 24 or more hours. Three electrodes are attached to the patient's chest and connected to a small portable ECG recorder by lead wires. The patient goes about his or her usual daily activities (except for activities such as taking a shower, swimming, or any activity causing an excessive amount of sweating which would cause the electrodes to become loose or fall off) during this procedure. There are 2 types of Holter monitoring:

  • Continuous recording. The ECG is recorded continuously during the entire testing period.

  • Event monitor, or loop recording. The ECG is recorded only when the patient starts the recording, when symptoms are felt.

Holter monitoring may be done when arrhythmia is suspected but not seen on a resting or signal-average ECG, since arrhythmias may be transient in nature and not seen during the shorter recording times of the resting or signal-average ECG.

 

 

Echocardiogram

 

(Echocardiography, Echo, Cardiac Ultrasound, Cardiac Ultrasonography, Cardiac Doppler, Transthoracic Echocardiogram, TTE)

Procedure overview

What is an echocardiogram?

An echocardiogram is a noninvasive (the skin is not pierced) procedure used to assess the heart's function and structures. During the procedure, a transducer (like a microphone) sends out ultrasonic sound waves at a frequency too high to be heard. When the transducer is placed on the chest at certain locations and angles, the ultrasonic sound waves move through the skin and other body tissues to the heart tissues, where the waves bounce or "echo" off of the heart structures. These sound waves are sent to a computer that can create moving images of the heart walls and valves.

An echocardiogram may utilize several special types of echocardiography, as listed below:

• M-mode echocardiography. This, the simplest type of echocardiography, produces an image that is similar to a tracing rather than an actual picture of heart structures. M-mode echo is useful for measuring heart structures, such as the heart's pumping chambers, the size of the heart itself, and the thickness of the heart walls.

• Doppler echocardiography. This Doppler technique is used to measure and assess the flow of blood through the heart's chambers and valves. The amount of blood pumped out with each beat is an indication of the heart's functioning. Also, Doppler can detect abnormal blood flow within the heart, which can indicate a problem with one or more of the heart's four valves, or with the heart's walls.

• Color Doppler. Color Doppler is an enhanced form of Doppler echocardiography. With color Doppler, different colors are used to designate the direction of blood flow. This simplifies the interpretation of the Doppler technique.

• 2-D (two-dimensional) echocardiography. This technique is used to "see" the actual motion of the heart structures. A 2-D echo view appears cone-shaped on the monitor, and the real-time motion of the heart's structures can be observed. This enables the doctor to see the various heart structures at work and evaluate them.

• 3-D (three-dimensional) echocardiography. 3-D echo technique captures three-dimensional views of the heart structures with greater depth than 2-D echo. The live or "real time" images allow for a more accurate assessment of heart function by using measurements taken while the heart is beating. 3-D echo shows enhanced views of the heart's anatomy and can be used to determine the appropriate plan of treatment for a person with heart disease.

Other related procedures that may be used to assess the heart include resting or exercise electrocardiogram (ECG or EKG), Holter monitor, signal-averaged ECG, cardiac catheterization, chest X-ray, computed tomography (CT scan) of the chest, electrophysiological studies, magnetic resonance imaging (MRI) of the heart, myocardial perfusion scans, radionuclide angiography, and cardiac CT scan. Please see these procedures for additional information.

Reasons for the procedure

An echocardiogram may be performed for further evaluation of signs or symptoms that may suggest:

• Atherosclerosis. A gradual clogging of the arteries over many years by fatty materials and other substances in the blood stream that can lead to abnormalities in the wall motion or pumping function of your heart. 

• Cardiomyopathy. An enlargement of the heart due to thickening or weakening of the heart muscle

• Congenital heart disease. Defects in one or more heart structures that occur during formation of the fetus, such as a ventricular septal defect (hole in the wall between the two lower chambers of the heart).

• Congestive heart failure. A condition in which the heart muscle has become weakened to an extent that blood cannot be pumped efficiently, causing fluid buildup (congestion) in the blood vessels and lungs, and edema (swelling) in the feet, ankles, and other parts of the body.

• Aneurysm. A dilation of a part of the heart muscle or the aorta (the large artery that carries oxygenated blood out of the heart to the rest of the body), which may cause weakness of the tissue at the site of the aneurysm.

• Valvular heart disease. Malfunction of one or more of the heart valves that may cause an abnormality of the blood flow within the heart.

• Cardiac tumor. A tumor of the heart that may occur on the outside surface of the heart, within one or more chambers of the heart (intracavitary), or within the muscle tissue (myocardium) of the heart.

• Pericarditis. An inflammation or infection of the sac that surrounds the heart.

An echocardiogram may also be simply performed to assess the heart’s overall function and general structure.

There may be other reasons for your doctor to recommend an echocardiogram.

Risks of the procedure

For some patients, having to lie still on the examination table for the length of the procedure may cause some discomfort or pain.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

Before the procedure

• Your doctor will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

• Generally, no prior preparation, such as fasting or sedation, is required.

• Notify your doctor of all medications (prescription and over-the-counter) and herbal supplements that you are taking.

• Notify your doctor if you have a pacemaker.

• Based on your medical condition, your doctor may request other specific preparation.

During the procedure

An echocardiogram may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor’s practices.

Generally, an echocardiogram follows this process:

1. You will be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your glasses, dentures, or hearing aids if you use any of these.

2. You will be asked to remove clothing from the waist up and will be given a gown to wear.

3. You will lie on a table or bed, positioned on your left side. A pillow or wedge may be placed behind your back for support.

4. You will be connected to an ECG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. The ECG tracings that record the electrical activity of the heart will be compared to the images displayed on the echocardiogram monitor.

5. The room will be darkened so that the images on the echo monitor can be viewed by the technologist.

6. The technologist will place warmed gel on your chest and then place the transducer probe on the gel. You will feel a slight pressure as the technologist positions the transducer to obtain the desired images of your heart.

7. During the test, the technologist will move the transducer probe around and apply varying amounts of pressure to obtain images of different locations and structures of your heart. The amount of pressure behind the probe should not be uncomfortable. If it does make you uncomfortable, however, let the technologist know.

8. After the procedure has been completed, the technologist will wipe the gel from your chest and remove the ECG electrode pads. You may then put on your clothes.

After the procedure

You may resume your usual diet and activities unless your doctor advises you differently.

Generally, there is no special type of care following an echocardiogram. However, your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

Online resources

The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease, or replace the professional medical advice you receive from your doctor. Please consult your health care provider with any questions or concerns you may have regarding your condition.

This page contains links to other websites with information about this procedure and related health conditions. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these websites, nor do these sites endorse the information contained here.

American College of Cardiology

American Heart Association

National Heart, Lung, and Blood Institute (NHLBI)

National Institutes of Health (NIH)

National Library of Medicine

 

Northeastern researchers work to stop sudden cardiac death among young athletes

March 17, 2016 by Thea Singer

As March Madness captures the imagination of sports fans across the country, it also serves as a stark reminder of a frightening trend. On average, every three days a competitive athlete in the U.S. succumbs to from sudden cardiac death. Gianmichel Corrado, head team physician at Northeastern, is on a mission to change that. Photo by Adam Glanzman/Northeastern University

 

March Mad­ness: It’s a time of buzzer-​​beaters and bracket-​​busters, seed debates and the Sweet 16, as the 68-​​team NCAA men’s bas­ket­ball tour­na­ment hijacks our lives over a three-​​week stretch known as the Big Dance.

But it’s also a stark reminder of a fright­ening trend: the preva­lence of sudden car­diac death, or SCD, among young com­pet­i­tive ath­letes. It was 26 years ago this month that Loyola Mary­mount star Hank Gathers, just 23, col­lapsed on the court at the university’s Ger­sten Pavilion and died shortly there­after. Diag­nosis: SCD.

He’s not the only one. On average, every three days a com­pet­i­tive ath­lete in the U.S. dies from SCD, according to an article in the journal Cir­cu­la­tion, often due to an unde­tected con­gen­ital heart con­di­tion called hyper­trophic cardiomyopathy—an abnormal thick­ening of mus­cles in the heart’s left lower chamber.

Gian­michel Cor­rado, head team physi­cian at North­eastern, is on a mis­sion to change that.

Cor­rado leads a research team that is devel­oping a new pre-​​participation screening prac­tice to iden­tify ath­letes at risk for SCD: Echocar­dio­g­raphy per­formed by front­line physi­cians using portable ultra­sound machines to detect heart abnor­mal­i­ties. Early results with North­eastern ath­letes show the pro­tocol to be sig­nif­i­cantly faster, less costly, and more accu­rate than cur­rent screening methods, reducing the rate ath­letes are referred to car­di­ol­o­gists for false-​​positive heart abnor­mal­i­ties by 33 percent.

A review of the research appears in an article in the March issue of Advanced Sports Med­i­cine Con­cepts and Controversies.

“Echo, done reg­u­larly, shows how much a heart can change struc­turally over time,” says Cor­rado, who prac­tices sports med­i­cine and is the asso­ciate sports med­i­cine fel­low­ship director at Boston Children’s Hos­pital. It uses high-​​frequency sound waves to pro­duce moving images of the heart, including the cham­bers and valves. “So if someone has an under­lying patho­log­ical con­di­tion, you can track any abnormal thick­ening and mis­align­ment of the muscle fibers and pro­vide treat­ment before it’s too late.”

Cur­rent methods insufficient

Cor­rado knows whereof he speaks: He wit­nessed SCD first­hand as a 22-​​year-​​old premed stu­dent playing pickup bas­ket­ball in Raleigh, North Car­olina. “A young African Amer­ican man just died,” he recalls. “I sat there and watched the resus­ci­ta­tion, another kid screaming at him to breathe and live.”

The screening pro­posed by Dr. Cor­rado is quick and has the poten­tial to pre­vent an ath­lete with a heart abnor­mality from dying while exer­cising.
— Jonathan Finnoff, med­ical director, Mayo Clinic Sports Med­i­cine Center

Two screening methods are used today: the Amer­ican Heart Association’s 14-​​element his­tory and phys­ical exam, which is “very vague,” says Cor­rado, and elec­tro­car­dio­grams, or EKGs, which mea­sure the heart’s elec­trical activity. EKGs, which are gen­er­ally not part of U.S. screen­ings, have been roundly crit­i­cized for their high rate of false pos­i­tives. Indeed, last March, when the NCAA’s chief med­ical officer rec­om­mended that all male col­lege bas­ket­ball players have the test, some 100 uni­ver­sity team physi­cians fired off a peti­tion in protest. EKGs also miss impor­tant clues: According to the Amer­ican Heart Asso­ci­a­tion, at least one in 10 people with hyper­trophic car­diomy­opathy have a normal EKG.

An echocar­dio­gram, on the other hand, has “an incred­ibly high ceiling” when it comes to pos­sible appli­ca­tions, says Cor­rado. They range from catching abnor­mal­i­ties before a con­di­tion goes over the edge to under­standing how non­patho­log­ical changes in the heart from inten­sive exer­cise relate to performance.

“The screening pro­posed by Dr. Cor­rado is quick and has the poten­tial to pre­vent an ath­lete with a heart abnor­mality from dying while exer­cising,” says Jonathan Finnoff, med­ical director of the Mayo Clinic Sports Med­i­cine Center, in Min­neapolis, Min­nesota, and a team physi­cian for the Min­nesota Tim­ber­wolves and Lynx. “Although fur­ther research is required, per­forming it during the pre-​​participation phys­ical exam may enable physi­cians to cor­rectly iden­tify struc­tural abnor­mal­i­ties of the heart, helping to lower the risk of SCD and the need for unnec­es­sary tests.”

Metic­u­lous research

Cor­rado and his col­leagues began their research cau­tiously. After writing sev­eral papers on the fea­si­bility of the prac­tice, they learned how to best use portable ultra­sound machines at the knee of Fred­erick C. Basilico, physician-​​in-​​chief for med­i­cine at Boston’s New Eng­land Bap­tist Hos­pital and car­di­ol­o­gist to the Boston Celtics. They then con­ducted two clin­ical studies (found here and here) to ensure that their echo mea­sure­ments were as accu­rate as those of Basilico and a reg­is­tered car­diac sono­g­ra­pher at the hos­pital. They were.

In a follow-​​up clin­ical study, pub­lished in 2014, they put the new pro­tocol into prac­tice at North­eastern. They screened 65 male student-​​athletes, ages 18 to 25, three ways: with the stan­dard his­tory and phys­ical exam, with an EKG, and with an echocar­dio­gram per­formed by Corrado.

Corrado’s pro­tocol cut the referral rate to car­di­ol­o­gists resulting from false pos­i­tives by one-​​third. “That showed the world: Look how effec­tive this can be on a col­lege campus,” he says.

“By relying on just the his­tory and phys­ical exam, there is an under­lying risk that we’re clearing ath­letes who poten­tially have under­lying dis­ease that could put them at risk for SCD,” says Basilico, a co-​​author on sev­eral of the studies. “Med­i­cine is moving toward using bed­side ultra­sound as a help in eval­u­ating patients in gen­eral in set­tings such as emer­gency rooms. It’s low-​​cost, there’s no radi­a­tion, and it takes just one to five min­utes. Gian Cor­rado asked, ‘Why can’t we train the sports med­i­cine physi­cians to do a brief ultra­sound during screening to help deter­mine if an ath­lete is eli­gible to par­tic­i­pate in sports?’ I think the idea is very good; it gives us addi­tional information.”

North­eastern could be the head­quar­ters of a mul­ti­center trial that helps end these tragedies.
— Gian­michael Cor­rado, Northeastern’s head team physician

Corrado’s com­mit­ment to the prac­tice extends beyond its diag­nostic value to its social rel­e­vance: Only cer­tain seg­ments of society, he says, have access to screening by a car­di­ol­o­gist. Pre-​​participation echocar­dio­g­raphy by a front­line physi­cian brings us one step closer to lev­eling that playing field.

Sports med­i­cine physi­cians at sev­eral other uni­ver­si­ties in the NCAA have expressed interest in the echo pro­tocol, says Cor­rado, who has another clin­ical study ready for pub­li­ca­tion that includes both a cost and an effi­ciency analysis of the three screening methods. “Our hope now is to get the funds to send 10 portable ultra­sounds to 10 NCAA insti­tu­tions and to train the team physi­cians,” he says. “North­eastern could be the head­quar­ters of a mul­ti­center trial that helps end these tragedies.”

 

Background
Participation in sports and other physical activity has many health benefits, and is an important part of staying healthy as a person gets older. However, for some people with underlying heart problems, the stress to the heart during exercise can also be dangerous. Older athletes are at increased risk of having a heart condition called coronary artery disease, which is narrowing of the blood vessels on top of the heart that supply oxygen containing blood to the muscle walls of the heart.

Symptoms
Many masters athletes with underlying heart problems have no symptoms. Occasionally there will be warning signs, such as a decrease in athletic performance, passing out, unusually significant shortness of breath, and chest pain during exercise.

Sports Medicine Evaluation and Treatment
A sports medicine physician will begin by exploring risk factors for heart disease, which includes reviewing family history, asking about possible symptoms, measuring blood pressure, and listening for heart murmurs (an irregular sound of the beating heart). When someone has symptoms or risk factors for heart disease, additional testing may be needed. Additional tests may include a resting ECG (electrocardiogram), a stress test (an ECG while exercising), and/or an echocardiogram (an ultrasound of the heart). Treatment can include reducing the risk of heart disease through lifestyle changes including diet and exercise, and treatment of high blood pressure with medications.

Injury Prevention
The main goal of screening for underlying heart problems by ECGs and stress tests is to prevent a masters athlete from experiencing a heart attack or sudden death from an irregular heart rhythm causing the heart to stop beating. In the event of a sudden death, survival is possible with early CPR (cardiopulmonary resuscitation) and an electric shock from an AED (automated external defibrillator).

Return to Play
If a masters athlete is found to not have underlying heart problems, there are no restrictions on sports participation. However, for those who have had a prior heart attack or who have significant heart disease, participation in high-intensity competitive sports are not advised. A sports medicine physician will assist with determining which sports are safe to play. If at any time symptoms of an underlying heart problem are experienced, an athlete must return for addition testing and refrain from physical activity in the meantime.

AMSSM Member Authors
Brett Toresdahl, MD and Chad Carlson, MD

References
Maron BJ, Araújo CG, Thompson PD, et al. Recommendations for preparticipation screening and the assessment of cardiovascular disease in masters athletes: an advisory for healthcare professionals from the working groups of the World Heart Federation, the International Federation of Sports Medicine, and the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation. 2001;103(2):327.

 

Athletes take cardiac tests to heart

Local students undergo free screenings at RiverBend to help prevent a worst-case scenario during a game

 

By Diane Dietz

The Register-Guard

 

 

This is a hard subject for parents to think about, let alone talk about, but those parents who took their teens to the cardiac screening at Sacred Heart Medical Center at RiverBend on Saturday knew the score.

“You watch the news, you watch sports, and there are athletes, who are otherwise healthy, end up with some cardiac event, out of the blue, that no one expected, that no one ever thought to look for,” said Scott Rosenfeld, who brought his basketball-playing teen, Hannah, to the clinic.

 

What happens is this: one second a young adult athlete is racing down field and the next second they’re dead.

For many, that’s the first symptom. Death.

Cardiologist call it sudden cardiac arrest or sudden cardiac death, and the best figures available say it happens to one athlete in about 44,000 each year.

Although that’s long odds, a parent weighs the costs and benefits of cardiac screening, Rosenfeld said. The costs of going to a free screening are minimal, he said, and the risks of undergoing an electrocardiogram, known as an EKG, are near zero. But if the worst happens during a game, it’s catastrophic.

So, he towed his Pokémon-playing daughter, who’ll be on the freshman basketball team at South Eugene High School this year, to an early morning appointment at RiverBend.

 

“It’s like flood insurance if you live on a mountain top,” he said. “But on the off hand chance that something happens, it’s not a bad idea to have (the EKG) done, if you can.”

For some, a mountain isn’t high enough.

In 1990, top-scoring college basketball player Hank Gathers dropped dead during a game at Los Angeles with the ESPN cameras rolling. He had the silent killer hypertrophic cardiomyopathy, a thickening of the heart wall that can, during hard play, cause fatal heart arrhythmias.

One month later, LaCenter, Wash., freshman Cody Sherell died at his basketball team’s first practice of the year. His coach wasn’t able to revive him.

In 2005, Portland high school basketball player David Heller died in his sleep after a game. He, too, had hypertrophic cardiomyopathy. Now, his family advocates for athlete heart screenings.

In 2011, Oregon State University football defensive tackle Fred Thompson died playing pick-up basketball at the Dixon Rec Center. Again, hypertrophic cardiomyopathy.

By the numbers

EKGs can detect hypertrophic cardiomyopathy — and some other fatal heart conditions — 90 percent of the time, so some cardiologists, especially sports cardiologists, argue that every young athlete should be screened.

If caught, cardiac surgeons can implant an internal defibrillator to prevent future arrests.

University of Washington researcher Dr. Jonathan Drezner — who is a team physician for the Seahawks and the Huskies — set out to pin down the exact number of athletes expected to die during or one hour after exertion because of some underlying heart problem.

He acquired databases with names of all NCAA players for 2004 to 2008 and the names of all those who died suddenly in that period of time. With those, he had a good numerator and denominator with which to calculate the incidence of sudden cardiac death, which is something nobody before had gotten a hold of.

He found one sudden death per 43,770 NCAA players per year. But in certain groups, the chances skyrocketed: for Division 1 male basketball players, the rate is one death in every 3,126 per year.

Black male athletes in all sports and all divisions face an “alarmingly high” one-in-18,000 sudden death rate per year, the study said.

Cardiac arrest is the No. 1 cause of medically related deaths among NCAA athletes, Drezner and his co-authors found. The highest risk sports are basketball, football, cross-country, swimming and lacrosse.

“Although the sudden cardiac death rate determined in the present study is high; there is some evidence that high school athletes are at increased risk compared with collegiate athletes,” according to the study.

Drezner argues, accordingly, that to save lives, all young athletes should be screened with an EKG.

“He’s very supportive of it, and I agree too,” said Dr. Frances Munkenbeck, one of several cardiologists on Saturday examining young athletes — kids who were lucky enough to have a parent reading Facebook when notice of the free screening appeared.

All 100 slots were filled in a couple of hours.

More than a dozen gift shop volunteers were on hand to escort the teens through a series of rooms to check height and weight, perform the EKG and do a thoroughgoing cardiology exam.

Marla Ingram, who snatched slots for her daughter, Jasmine, who plans to play rugby at the University of Oregon this year, and son Myles, 14, who wants to run hurdles and high jump at Sheldon High School this year.

“We see in the news so many of these kids nowadays, playing basketball or football, and they have a heart condition on the court,” Ingram said.

Her soft-spoken son, Myles, stretched out on the exam table while medical assistant Jessica LeDoux covered his chest with a dozen wires. She connected the snaking wad to a laptop, which spit out a graph of his heart rhythms in about a minute.

Next, pediatric cardiologist Misty Carlson read the EKG, questioned Myles and his mom about his family history or whether he got dizzy or faint when playing hard or whether he’d felt chest pains.

She put on a pink stethoscope and listened to his heart in more than a half dozen places — neck, chest, back, groin — with Myles laying down, then standing up. Carlson listened so intently, sometimes she closed her eyes.

“Good. Everything is normal,” she said. She followed the same protocol and came to the same conclusion with Jasmine.

“It makes me feel good to know that both of them are healthy,” Ingram said. “Their hearts are good — and when they go out to play sports, I don’t have to worry because they don’t have any issues.”

The assurance, though, isn’t 100 percent. Hypertrophic cardiomyopathy, for example, usually doesn’t emerge until adolescence in tandem with growth spurts, so it may not show up on a given exam but manifest later, the doctors said.

Not all cardiologists think its a good idea to do an EKG on every young athlete. Carlson, for example, has serious qualms, and her views are consistent with American Heart Association recommendations.

The cost is one issue, she said. “Where is that money coming from? And maybe that money is better spent for other things we need in our health care system?”

EKGs may unmask some conditions that would otherwise go undetected, she said, but, practically, there aren’t enough cardiologists to read EKGs for all young athletes.

“We’re just already saturated with — already taking care of — the population we have, rather than adding, for lack of a better word, a burden,” she said.

If only some groups can be screened, which ones?

“It brings up a lot of ethical/moral questions,” Carlson said. “We talk about screening athletes, but is it just the competitive athlete? Is it the kid who plays on a team sport or is it the one who does an individual sport. Is it a dancer? Any of those kids can be at risk; it’s not just the kids who are ultra-competitive athletes,” she said.

Ducks athletics provide EKGs for all 500 of UO’s competitive athletes, male or female, according to spokesman Craig Pintens. OSU began doing so, too, in the wake of Thompson’s death.

“Some schools are doing it; some schools aren’t,” Munkenbeck said. “The NCAA is not mandating it yet.”

Sudden cardiac death is a high-priority area for research funded by the Pac-12, according to conference announcement in July.

The Pac-12 gave Drezner’s group a grant to answer “critical questions” about screening by comparing universities that provide EKGs with those who go with a traditional physical exam.

“The study will compare conditions identified, total costs, costs per diagnosis, time lost from competition, and any adverse outcomes related to screening with each strategy,” the announcement said.

For high school students, meanwhile, careful sports physicals by primary care doctors can lead to the detection of heart conditions, Carlson said.

Many of the conditions run in families, so the doctors should ask detailed questions about early cardiac-related deaths in close family members, she said. Doctors also should ask questions about symptoms that could be related, such as sudden fatigue during exertion, fainting and chest pain.

Carlson counsels doctors to “have a low threshold in getting a work up for those kids. If they have chest pain whenever they run, it could be asthma or it could be chest wall pain,” she said. “But if it’s definitely with exertion, those kids deserve a work up. We’ve got to make sure there’s nothing else going on. ...

“I cringe when I hear about mass sports physicals where they shuffle kids really quickly through. They don’t always do a thorough history. They don’t always involve the parent,” she said.

Save a life

The Sacred Heart screening took pains to give the young athletes confidence that they could save a teammate’s life, if ever needed.

A teacher helped them practice chest compressions on CPR dummies, and they shocked the dummys’ “hearts” with automated external defibrillators.

The problem is, people don’t start chest compressions right way because they know what sudden death looks like, Munkenbeck said. They mistake it for a seizure or something else, and the results are fatal.

“With Frank Gathers,” she said, “they didn’t start CPR on him right away. They didn’t know what it was — and they should have because he had issues — and they had an AED on the sidelines that wasn’t used.”

The Washington basketball player, Sherell, wasn’t revived by an AED, although the school owned a unit, because the coach couldn’t locate the AED paddles, a review of 9-1-1 tapes found.

The parents of children lost to sudden cardiac death frequently become the staunchest advocates for universal EKG screenings and locating AEDs wherever teenagers play hard. See the David Heller Foundation out of Scappoose or the Nick of Time Foundation out of Mill Creek, Wash.

“It makes a huge difference. You can really save a life,” Munkenbeck said.

Stories of young lives saved occasionally brighten the news. In 2010, Portland football player Hayward Demison III collapsed from sudden cardiac arrest after he ran in a touchdown. A nurse watching from the stands revived him.

In 2011, Clackamas Community College baseball player Cody Ching, during practice, fell without warning from sudden cardiac arrest. His coach started CPR. Medics took over and Ching survived.

Follow Diane on Twitter @diane_dietz . Email diane.dietz@registerguard.com .

More Health articles »

 

Is My Resting Heart Rate Too Low?

3/9/15

How regular endurance training can reduce a runner’s heart rate

Brett asks: I am a 60-year-old runner and I’ve been running for about four years now. My resting heart rate used to be 60 bpm (beats per minute). Last year in my prime shape after running four marathons in four months, I had a resting heart rate of 38 bpm. That is when I am sitting watching TV. It could be lower when I am sleeping, but I have not tested this yet. Thirty eight bpm scares me. Is this normal for someone my age who is in pretty good condition? Thank you for your time.

A heart rate of 38 beats per minute (bpm) can be normal in a well-trained endurance runner at age 60. The heart rate normally lowers at rest. And distance running over four years could cause a reduction in resting heart rate from 60 bpm to 38 bpm. The “normal” heart rate range is usually between 60 bpm and 100 bpm and is most accurately measured when you first wake up before you begin to move around for the day.

 

A heart rate of less than 60 is called a bradycardia, or slow heart rate. It is not unusual for healthy people involved in endurance activities to develop a bradycardia based on the increased vagal tone from training that suppresses heart rate. Training also increases the heart size so it can push out a greater volume of blood to the body with each contraction. A lower heart rate will deliver the same blood volume in a trained resting heart as the higher heart rate in an untrained heart. Detraining or stopping regular endurance exercise will reverse both effects, so a runner taken out of commission by illness or injury will have to regain the changes with training after recovery.

 

For you at age 60, a resting heart rate around 40 is nothing to fear as long as you are well and you do not have any symptoms of lightheadedness, fainting, blacking out, shortness of breath, or chest pains, and your heart rate responds to exercise by increasing to meet the blood flow demands. It is common for well-trained people to feel a bit lightheaded when moving quickly from a squat to stand, so you may find you have to stand still for a moment to let the blood reach your brain if you have been reaching to the floor or squatting for any length of time.

 

There is some evidence suggesting that exercise-related bradycardia can become permanent and potentially problematic in lifetime endurance athletes, but I would not quit exercise based on the current data. You could likely maintain your health and fitness with a much lower volume of running than it takes to complete four marathons in four months.

 

Pulse & Heart Rate

Your blood pressure is the force of your blood moving through your blood vessels, your heart rate is the number of times your heart beats per minute.

What is your pulse?

Your pulse is your heart rate, or the number of times your heart beats in one minute. Pulse rates vary from person to person. Your pulse is lower when you are at rest and increases when you exercise (more oxygen-rich blood is needed by the body when you exercise). Knowing how to take your pulse can help you evaluate your exercise program.

How to take your pulse

 

1. Place the tips of your index, second and third fingers on the palm side of your other wrist below the base of the thumb. Or, place the tips of your index and second fingers on your lower neck on either side of your windpipe.
2. Press lightly with your fingers until you feel the blood pulsing beneath your fingers. You may need to move your fingers around slightly up or down until you feel the pulsing.
3. Use a watch with a second hand, or look at a clock with a second hand.
4. Count the beats you feel for 10 seconds. Multiply this number by six to get your heart rate (pulse) per minute.

Count your pulse: _____ beats in 10 seconds x 6 = _____ beats/minute

What is a normal pulse?

Normal Heart Rates at Rest:

• Children (ages 6 - 15) 70 – 100 beats per minute
• Adults (age 18 and over) 60 – 100 beats per minute

 

Valley City trainer, Jamestown EMS cooperate to save man's life

Aug. 5—JAMESTOWN — Tabitha Muncy has gotten used to making a difference as the head athletic trainer at Valley City High School.

But on June 12, in Jamestown, she was quite possibly the difference between life and death.

"Technically there should be an athletic trainer at any athletic event whether that be a practice, game, or camp," Muncy said. "I was asked by the UJ men's basketball coach to work this high school boys' basketball camp. I was a little hesitant as this was my first time working at a camp, but I thought why not, I've heard nothing usually ever happens at camps anyways."

The operative word being "usually"

"I happened to be walking into the gym when I noticed a group of people surrounding someone lying on the ground," Muncy said in reflection. "I ran over and was told this coach immediately collapsed and hit his head. After finding he had no pulse I made the call to begin CPR.

"911 had already been called and I instructed another coach to grab the AED (Automated External Defibrillator)," she said.

According to the Red Cross website:

"An AED, or automated external defibrillator, is used to help those experiencing sudden cardiac arrest. It's a ... medical device that can analyze the heart's rhythm and, if necessary, deliver an electrical shock, or defibrillation, to help the heart re-establish an effective rhythm."

Muncy said after putting on the AED, the device advised for a shock, and a shock was given. Muncy then continued chest compressions until she was relieved by the Emergency Medical Technicians (EMTs).

"Thinking back to this day seems like a blur," Muncy said. "I have been CPR certified for seven years, so once I began my actions were pure instinct. I didn't realize the adrenaline rush I had until after he was transferred to the ambulance and I was completely physically and mentally exhausted."

Muncy became a certified EMR (Emergency Medical Responder) for the Dazey Fire Department when she was 16 years old.

"I realized I loved the thrill of assisting with medical emergencies," Muncy said. "I combined this love with my passion for sports and decided to go into athletic training (in college)."

Muncy has been a certified athletic trainer for one year. In her position at Valley, she provides care at practices and games for athletes in all sports. At camps, she is primarily there if emergency care is needed.

"Athletic trainers specialize in injury prevention, emergency care, and evaluating and diagnosing sports-related injuries — we do a lot more than tape ankles and hand out ice bags," Muncy said. "We are health care professionals."

After about five to 10 minutes of performing CPR, the EMS crews arrived and Muncy articulated what had happened to paramedic, Kevin Bousquet, and EMT Maven Moore.

"EMS crews put the patient on our cardiac monitor where the paramedic could interpret the rhythm himself and he determined that the patient was still in Cardiac Arrest and defibrillated him again," Jamestown Area Ambulance Operations Manager Andrew Berkey said. "Shortly after that he regained pulses but was still in a very unstable rhythm."

Berkey said, due to the irregular rhythm, the paramedic performed a cardioversion which is a procedure that uses quick, low-energy shocks to restore a regular heart rhythm.

"(The cardioversion) did convert this person into a stable rhythm," Berkey said. "From that point, we started to administer 'return of spontaneous circulation' — that is basically making sure those vitals remain stable."

Return of spontaneous circulation involves starting IVs, starting fluids and getting any supportive medications that might be needed by the patient. After vitals were stable, EMS crews secured the patient onto a cot, loaded him into the ambulance and transported him to Jamestown Regional Medical Center. The patient's name was not disclosed.

"We do quite a few cardiac arrest calls per year but that is a bit of an unusual setting," Berkey said. "I am proud of our teams. These guys work very, very hard at what they do. It's a long battle in EMS and you don't always get the wins but when you do, you need to recognize them and appreciate them."

While it was the EMS crews who got the pulses back, Berkey stressed that saving the coach's life was a collaborative effort between his team and Muncy.

"If (Muncy) didn't start what she did, it would be incredibly unlikely that this guy would be alive," Berkey said. "In rural areas, we need bystanders to start CPR. We're not in urban areas where there is an ambulance waiting around every corner so we need people to take immediate action.

"I got in contact with Tabitha right away and thanked her for what she did because it's that important," he said. "That outcome was way less likely if she didn't step in."

Berkey said the national survival rate of out-of-hospital cardiac arrests is 10%.

"If we want to raise that number we have to train more people," Berkey said.

Berkey spent most of Tuesday, Aug. 1, teaching the entire University of Jamestown Athletics Department CPR. Berkey said the athletics department is now CPR certified.

"I think the universe has given us plenty of examples in the last year of why this matters," Berkey said of training individuals. "You look at Damar Hamlin, you see Lebron James' son in the news the other day — the big thing people have to understand is that no one is off limits to this. There are 100 different things that could cause someone to go into cardiac arrest.

"What Tabitha did was start the process of getting pulses back," he said. "That's huge. The more people that are trained, the sooner we can provide the right care and ultimately the more people we are going to save. We need more people like Tabitha who are willing to step up and do the right thing."