901-68 Prospective Screening of 5615 High School Athletes for Sudden Cardiac Death

Screening for common causes (hypertrophic cardiomyopathy and anomalous coronary artery) of sudden cardiac death (SCD) in high school athletes (HSA) during pre-participation exams is varied and relatively unstudied. Efforts to improve diagnoses of potentially serious or lethal congenital heart conditions are needed. We prospectively evaluated HSA at 34 different high schools over three years. Cardiovascular screening included obtaining a history of angina or anginal equivalents, or a family history of SCD before age 35 years. A 12-lead EKG and a cardiovascular physical exam were performed. Abnormalities resulted in a cardiac ultrasound (CU). Abnormal EKG for LVH was defined in boys as SVl and RV5>50 mm and in girls as SVl plus RV5>40 mm. Follow-up of cardiovascular abnormalities followed 16th Bethesda Conference Guidelines.Results5.615 HSA (3378 boys, 2237 girls) were evaluated. 115 (2%) had abnormal cardiovascular history, 196 (3.5%) had abnormal cardiovascular exam, 193 (3.5%) had abnormal EKG and 126 (2%) had combined abnormalities. All 630 (11%) with abnormal cardiovascular screening underwent CU at the time of their exam. 43 HSA (7% of CU performed) were found to have minor abnormalities. No serious previously undetected abnormality was noted with CU. No LVH was seen in 28 HSA with LVH by ECG. 5140 (91.5%) HSA were approved for competitive sports; 435 (7.8%) HSA were approved for competitive sports after follow-up by local M.D. (recommended primarily for evaluation of mild hypertension); 40 (0.7%) HSA were not approved due to anginal symptoms (n=16) requiring subsequent treadmill testing (all of which were normal); systolic BP>170 or diastolic BP>110 (n=5), carotid bruit (n=2), severe Al by exam (n=1), WPW (n=6). PVC's (n=5), RBBB (n=4), SVT (n=1). EKG alone led to disqualification in 16 or 1/350 HSA undergoing screening. No cases of hypertrophic cardiomyopathy or anomalous coronary artery were detected prospectively. One SCD occurred in an approved HSA due to anomalous coronary artery.ConclusionsCommon causes of SCD in HSA are rare and/or methods to detect them are insensitive; serious CU abnormalities in this population are rare; EKG added to the cardiovascular history and physical exam increases the ability to detect potentially serious abnormalities necessitating further cardiovascular testing before approval for competitive sports