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Abbas R, Abbas A, Khan TK, Sharjeel S, Amanullah K, Irshad Y. Sudden Cardiac Death in Young Individuals: A Current Review of Evaluation, Screening and Prevention. J Clin Med Res 2023; 15:1-9. [PMID: 36755763 PMCID: PMC9881489 DOI: 10.14740/jocmr4823] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/04/2023] [Indexed: 01/26/2023] Open
Abstract
Sudden cardiac death (SCD) can affect all age groups, including young persons. While less common in the age < 35 population, the occurrence of SCD in the young raises concern, with multiple possible etiologies and often unanswered questions. While coronary artery disease is the leading cause in those > 35 years of age, the younger population faces a different subset of pathologies associated with SCD, including arrhythmias and cardiomyopathies. The tragic nature of SCD in the young entails that we explore and implement available screening methods for this population, and perform the necessary investigations such as electrocardiography (ECG) and echocardiography. In this review, we not only explore the vast etiology associated with SCD in those age < 35, but emphasize evaluation methods, who is at risk, and delve into screening of SCD in potential victims and their family members, in an attempt to prevent this traumatic event. Future research must work towards establishing preventative measures in order to reduce SCD, particularly unexplained SCD in the young.
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Affiliation(s)
- Ramsha Abbas
- Institute of Molecular Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA,Corresponding Author: Ramsha Abbas, Institute of Molecular Cardiology, Department of Medicine, University of Louisville, Louisville, KY, USA.
| | - Aiza Abbas
- Medical College, Aga Khan University, Karachi, Sindh, Pakistan
| | - Talha Kamran Khan
- Shifa College of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Salal Sharjeel
- Dow Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Khadija Amanullah
- Medical College, National University of Medical Sciences, Rawalpindi, Punjab, Pakistan
| | - Yusra Irshad
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY, USA
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Topal L, Polyák A, Tóth N, Ágoston G, Bencsik P, Kohajda Z, Prorok J, Déri S, Nagy N, Jost N, Virág L, Farkas AS, Varró A, Baczkó I. Endurance training-induced cardiac remodeling in a guinea pig athlete's heart model. Can J Physiol Pharmacol 2022; 100:993-1004. [PMID: 35834825 DOI: 10.1139/cjpp-2022-0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Besides the health benefits of regular exercise, high-level training-above an optimal level-may have adverse effects. In this study, we investigated the effects of long-term vigorous training and its potentially detrimental structural-functional changes in a small animal athlete's heart model. Thirty-eight 4-month-old male guinea pigs were randomized into sedentary and exercised groups. The latter underwent a 15-week-long endurance-training program. To investigate the effects of the intense long-term exercise, in vivo (echocardiography, electrocardiography), ex vivo, and in vitro (histopathology, patch-clamp) measurements were performed. Following the training protocol, the exercised animals exhibited structural left ventricular enlargement and a significantly higher degree of myocardial fibrosis. Furthermore, resting bradycardia accompanied by elevated heart rate variability occurred, representing increased parasympathetic activity in the exercised hearts. The observed prolonged QTc intervals and increased repolarization variability parameters may raise the risk of electrical instability in exercised animals. Complex arrhythmias did not occur in either group, and there were no differences between the groups in ex vivo or cellular electrophysiological experiments. Accordingly, the high parasympathetic activity may promote impaired repolarization in conscious exercised animals. The detected structural-functional changes share similarities with the human athlete's heart; therefore, this model might be useful for investigations on cardiac remodeling.
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Affiliation(s)
- L Topal
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
| | - A Polyák
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- Department of Pediatrics and Pediatric Health Center, University of Szeged, Szeged, 6725, Hungary
| | - N Tóth
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
| | - G Ágoston
- Institute of Family Medicine, University of Szeged, Szeged, 6720, Hungary
| | - P Bencsik
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
| | - Zs Kohajda
- ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - J Prorok
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - Sz Déri
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
| | - N Nagy
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - N Jost
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, 6720, Hungary
| | - L Virág
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, 6720, Hungary
| | - A S Farkas
- Department of Internal Medicine, Cardiology, University of Szeged, Szeged, 6725, Hungary
| | - A Varró
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- ELKH-SZTE Research Group of Cardiovascular Pharmacology, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, 6720, Hungary
| | - I Baczkó
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Szeged, 6720, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Szeged, 6720, Hungary
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Das 12-Kanal-Ruhe-EKG in der sportmedizinischen Untersuchung von Kindern und Jugendlichen. Monatsschr Kinderheilkd 2019. [DOI: 10.1007/s00112-019-00796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Cardiovascular pre-participation screening in young athletes: Recommendations of the Association of European Paediatric Cardiology. Cardiol Young 2017; 27:1655-1660. [PMID: 28789718 DOI: 10.1017/s1047951117001305] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sudden death in young competitive athletes can be avoided by implementation of pre-participation screening programmes. A screening programme should be performed only by trained physicians and should include the athlete's personal and family history, physical examination results, and the readings from a 12-lead-electrocardiogram. The athlete should undergo this screening programme every second year to detect progressive diseases. In addition, the programme should include detailed instructions to the athletes to pause training during infections in order to prevent sudden death due to myocarditis.
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Gleason CN, Kerkhof DL, Cilia EA, Lanyi MA, Finnoff J, Sugimoto D, Corrado GD. Early Screening for Cardiovascular Abnormalities With Preparticipation Echocardiography: Feasibility Study. Clin J Sport Med 2017; 27:423-429. [PMID: 27755012 DOI: 10.1097/jsm.0000000000000379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The traditional history and physical (H&P) is a poor screening modality to identify athletes at risk for sudden cardiac death. Although better than H&P alone, electrocardiograms (ECG) have also been found to have high false-positive rates. A limited portable echocardiogram by a frontline physician (PEFP) performed during preparticipation physical examination (PPE) allows for direct measurements of the heart to more accurately identify athletes with structural abnormalities. Therefore, it is worthwhile to assess the feasibility of incorporating limited PEFP as part of PPEs. The aim of this study was to investigate the feasibility of incorporating limited screening PEFP into routine PPEs. METHODS Thirty-five Division I male collegiate athletes were prospectively enrolled in the study after informed consent was obtained. Each athlete underwent screening with H&P, ECG, and limited PEFP. The H&P was performed based on the 2007 twelve-element preparticipation cardiovascular screening guidelines from the American Heart Association. The ECGs were interpreted using the 2013 Seattle Criteria. The limited echocardiographic (ECHO) measurements were obtained in the parasternal long axis view. End-diastolic measurements were recorded for the left ventricular diameter (LVD), left ventricular posterior wall diameter (LVPWd), interventricular septal wall diameter (IVSWd), aortic root diameter, and ascending aorta. The length of time of each screening station was recorded and reported in seconds (sec) and compared by one-way repeated-measures of analysis of variance with pairwise Bonferroni correction. A priori alpha level was set as 0.05. RESULTS The length of time for screening was significantly shorter with limited PEFP (137.7 ± 40.4 seconds) compared with H&P (244.2 ± 80.0 seconds) and ECG (244.9 ± 85.6 seconds, P < 0.01). The screening time did not differ between H&P and ECG (P = 0.97). Six athletes had a positive finding in H&P screening and 3 athletes had positive ECG findings. One athlete had both a positive H&P and screening ECG. All 3 athletes with positive ECGs had negative limited PEFP screens. One athlete had a borderline posterior wall thickness (1.49 mm) on the limited screening PEFP evaluation and another was found to have a borderline IVSWd-to-LVPWd ratio (1.28). All 3 athletes with positive ECG findings and both athletes with a borderline finding on limited PEFP were referred for formal evaluation with a cardiologist. None of the 5 athletes were disqualified from competition after cardiac evaluation, but 1 of the athletes with a positive screening-limited ECHO needs annual monitoring. CONCLUSIONS Incorporating limited PEFP into PPEs has the potential to limit the number of false-positive and false-negative cardiac screens. Limited PEFP was the fastest screening modality compared with traditional H&P and ECG methods. Based on the time-driven activity-based paradigm of cost analysis, limited PEFP as part of the PPE yields the highest value: the most accurate and reliable information and the lowest dollar/time expenditure.
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Affiliation(s)
- Courtney N Gleason
- *Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, Massachusetts; †Harvard Medical School, Boston, Massachusetts; ‡Northeastern University, Boston, Massachusetts; §The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts; and ¶Mayo Clinic Sports Medicine Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic School of Medicine, Rochester, Minnesota
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Kerkhof DL, Gleason CN, Basilico FC, Corrado GD. Is There a Role for Limited Echocardiography During the Preparticipation Physical Examination? PM R 2016; 8:S36-44. [DOI: 10.1016/j.pmrj.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 12/24/2015] [Accepted: 01/01/2016] [Indexed: 01/29/2023]
Affiliation(s)
| | - Courtney N. Gleason
- Brown University Warren Alpert Medical School, Departments of Orthopedics and Pediatrics, Rhode Island Hospital, Providence, RI
| | | | - Gianmichel D. Corrado
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, 319 Longwood Ave, Boston, MA 02115; Harvard Medical School, Boston, MA; Northeastern University, Boston, MA; The Micheli Center for Sports Injury Prevention, Waltham, MA
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8
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The Impending Dilemma of Electrocardiogram Screening in Athletic Children. Pediatr Cardiol 2016; 37:1-13. [PMID: 26289947 DOI: 10.1007/s00246-015-1239-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 07/31/2015] [Indexed: 10/23/2022]
Abstract
Sudden cardiac death (SCD) affects 2/100,000 young, active athletes per year of which 40% are less than 18 years old. In 2004, the International Olympic Committee accepted the Lausanne Recommendations, including a 12-lead electrocardiogram (ECG), as a pre-participation screening tool for adult Olympic athletes. The debate on extending those recommendations to the pediatric population has recently begun. The aims of our study were to highlight the characteristics of the young athlete ECG, phenotypical manifestations of SCD-related disease in children, and challenges of implanting ECG screening in athletic children. A systematic review of the literature is performed. We searched available electronic medical databases for articles relevant to SCD, ECG, silent cardiac diseases, and athletic children. We focused on ECG screening and description in a pediatric population. We identified 2240 studies. Sixty-two relevant articles and one book were selected. In children, prepubertal ECG and the ECG phenotype of most SCD-related diseases differ notably from adults. The characteristics of the prepubertal ECG and of the phenotypical manifestation of SCD-related disease in children will result in less specific and less sensitive ECG-based screening programs. Those limitations advise against extending the adult recommendation to children, without further studies. Until then, history and physical exam should remain the cornerstone of screening for SCD-related pathologies in children.
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9
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Machado M, Vaz Silva M. Benign and pathological electrocardiographic changes in athletes. Rev Port Cardiol 2015; 34:753-70. [PMID: 26643438 DOI: 10.1016/j.repc.2015.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/01/2015] [Accepted: 07/25/2015] [Indexed: 01/02/2023] Open
Abstract
Sudden cardiac death is the leading cause of death in athletes during sport. It is a tragic event that generates significant media attention and discussion throughout society as to whether everything possible had been done to prevent it. Regular physical exercise causes cardiac remodeling at both the mechanical and electrical level, known as athlete's heart, resulting in an electrocardiogram (ECG) considered abnormal compared with the ECGs of the general population. Some of these electrocardiographic changes are considered normal or physiological in athletes, while others suggest underlying cardiac disease with the potential to cause sudden cardiac death. There is thus an urgent need to define the electrocardiographic patterns that allow or prohibit participation in sports, and to differentiate them in terms of gender, ethnicity and age. The purpose of this review is to present the latest data on the electrocardiographic changes considered benign or pathological that are typically found in athletes and to critically analyze the most recent criteria for classifying ECGs in this population (the Seattle criteria), comparing them with previous guidelines and with the latest studies on the subject. This article also examines the question of including ECGs in pre-participation screening programs, the US and European approaches to the subject, and the most up-to-date data on the sensitivity, specificity and cost-effectiveness of the ECG in athletes.
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Affiliation(s)
- Marino Machado
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.
| | - Manuel Vaz Silva
- Serviço de Cardiologia/Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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10
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Machado M, Vaz Silva M. Benign and pathological electrocardiographic changes in athletesBenign and pathological electrocardiographic changes in athletes. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.repce.2015.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Smallman DP, Webber BJ, Mazuchowski EL, Scher AI, Jones SO, Cantrell JA. Sudden cardiac death associated with physical exertion in the US military, 2005–2010. Br J Sports Med 2015; 50:118-23. [DOI: 10.1136/bjsports-2015-094900] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2015] [Indexed: 12/19/2022]
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12
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Sport- und Wettkampftauglichkeitsuntersuchungen im Kindes- und Jugendalter. Monatsschr Kinderheilkd 2015. [DOI: 10.1007/s00112-015-3355-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Bergeron MF, Mountjoy M, Armstrong N, Chia M, Côté J, Emery CA, Faigenbaum A, Hall G, Kriemler S, Léglise M, Malina RM, Pensgaard AM, Sanchez A, Soligard T, Sundgot-Borgen J, van Mechelen W, Weissensteiner JR, Engebretsen L. International Olympic Committee consensus statement on youth athletic development. Br J Sports Med 2015; 49:843-51. [PMID: 26084524 DOI: 10.1136/bjsports-2015-094962] [Citation(s) in RCA: 396] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Michael F Bergeron
- Youth Sports of the Americas, Birmingham, Alabama, USA Lemak Sports Medicine, Birmingham, Alabama, USA
| | - Margo Mountjoy
- Department of Family Medicine, Michael G DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada IOC Medical Commission-Games Group
| | - Neil Armstrong
- Children's Health and Exercise Research Centre, St Luke's Campus, University of Exeter, Exeter, UK
| | - Michael Chia
- Physical Education & Sports Science, National Institute of Education, Nanyang Technological University, Singapore
| | - Jean Côté
- Queen's University, School of Kinesiology and Health Studies, Kingston, Ontario, Canada
| | - Carolyn A Emery
- Alberta Children's Hospital Research Institute for Child and Maternal Health Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Avery Faigenbaum
- Department of Health & Exercise Science, The College of New Jersey, Ewing, New Jersey, USA
| | - Gary Hall
- Hallway Consulting, Los Olivos, California, USA
| | - Susi Kriemler
- Institut für Epidemiologie, Biostatistik und Prävention, Gruppe Children, Physical Activity and Health (CHIPAH), Universität Zürich, Switzerland
| | - Michel Léglise
- International Gymnastics Federation (FIG), Paris, France
| | - Robert M Malina
- University of Texas at Austin, Austin, Texas, USA Tarleton State University, Stephenville, Texas, USA
| | - Anne Marte Pensgaard
- Department of Coaching and Psychology, Norwegian School of Sport Sciences, Oslo, Norway
| | - Alex Sanchez
- International Basketball Federation (FIBA), Switzerland
| | - Torbjørn Soligard
- Medical & Scientific Department, International Olympic Committee, Lausanne, Switzerland
| | | | - Willem van Mechelen
- Department of Public & Occupational Health and EMGO+ Institute, VU University Medical Center Amsterdam, Amsterdam, The Netherlands School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa
| | | | - Lars Engebretsen
- Medical & Scientific Department, International Olympic Committee, Lausanne, Switzerland Orthopaedic Center, Ullevaal University Hospital, Oslo, Norway
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Abstract
Sudden cardiac death in the young is a relatively uncommon but marked event usually related to congenital diseases or anomalies. Despite the prevalence of each condition being variable, most common causes include primary myocardial diseases and arrhythmic disorder, frequently with inheritance pattern. Sudden cardiac death is usually preceded by symptoms, thus making personal and family history fundamental for its prevention. Nevertheless, in more than 50% of cases, sudden cardiac death is the first manifestation of the disease. In this review, we describe the different causes of sudden cardiac death, their incidence, and currently used preventive strategies.
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Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12–25 Years of Age). Circulation 2014; 130:1303-34. [DOI: 10.1161/cir.0000000000000025] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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16
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Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment of the 12-lead electrocardiogram as a screening test for detection of cardiovascular disease in healthy general populations of young people (12-25 years of age): a scientific statement from the American Heart Association and the American College of Cardiology. J Am Coll Cardiol 2014; 64:1479-514. [PMID: 25234655 DOI: 10.1016/j.jacc.2014.05.006] [Citation(s) in RCA: 140] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Toresdahl BG, Rao AL, Harmon KG, Drezner JA. Incidence of sudden cardiac arrest in high school student athletes on school campus. Heart Rhythm 2014; 11:1190-4. [DOI: 10.1016/j.hrthm.2014.04.017] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Indexed: 12/01/2022]
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Asif IM, Johnson S, Schmieg J, Smith T, Rao AL, Harmon KG, Salerno JC, Drezner JA. The psychological impact of cardiovascular screening: the athlete's perspective. Br J Sports Med 2014; 48:1162-6. [DOI: 10.1136/bjsports-2014-093500] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Berg A, Bråtane E, Odland HH, Brudvik C, Rosland B, Hirth A. [Cardiovascular risk assessment for the use of ADHD drugs in children]. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2014; 134:710-4. [PMID: 24721858 DOI: 10.4045/tidsskr.13.0565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Drug therapy for ADHD (Attention Deficit Hyperactivity Disorder) has generally been regarded as safe. ECG screening of healthy children and adolescents before initiating this type of treatment appears to be usual in Norway, despite recommendations that ECGs should only be undertaken in individuals who are at risk. The purpose of this article is to clarify relevant guidelines for cardiovascular risk assessment for the use of ADHD drugs in children and adolescents, as well as to propose practical recommendations. METHOD The article is based on a literature search in PubMed completed on 1 October 2013, and on the author's own clinical experience and discretionary assessments. RESULTS The use of CNS stimulants and atomoxetine is associated with a slight rise in blood pressure and pulse rate, as well as small changes in QT interval. A small percentage of patients (5-10%) experience a clinically significant rise in blood pressure and pulse rate. Sudden death does not appear to occur more frequently in children and adolescents taking ADHD drugs in therapeutic doses than in children and adolescents who do not use such drugs. There is little knowledge available on the long-term effects of ADHD drugs on the cardiovascular system of otherwise healthy individuals, or on the risk related to the use of ADHD drugs in children and adolescents with cardiac disease. The drugs are thought to increase the risk of sudden cardiac death in some arrhythmia syndromes. INTERPRETATION Our assessment is that caution should be exercised in the use of ADHD drugs in children with potentially dangerous cardiac arrhythmias. We recommend clinical examination and a thorough medical history review in order to identify individuals at risk before initiating drug therapy, and also suggest that it is not necessary for healthy children to be given an ECG examination before introducing ADHD drugs. In children with known cardiac disease, arrhythmia or risk factors for cardiac disease, ADHD treatment should be undertaken in consultation with a medical specialist with competence in pediatric cardiology.
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Affiliation(s)
- Ansgar Berg
- Barneklinikken Haukeland universitetssykehus og Klinisk institutt 2 Universitetet i Bergen
| | | | | | | | | | - Asle Hirth
- Barneklinikken Haukeland universitetssykehus
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Heron N, Cupples M. The health profile of football/soccer players in Northern Ireland - a review of the uefa pre-participation medical screening procedure. BMC Sports Sci Med Rehabil 2014; 6:5. [PMID: 24521343 PMCID: PMC4021641 DOI: 10.1186/2052-1847-6-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Accepted: 02/10/2014] [Indexed: 01/16/2023]
Abstract
Background It is compulsory that domestic football/soccer teams in UEFA competitions organise players’ pre-participation medicals. Although screening guidelines have been established, these remain controversial. The findings of medical examinations can have lasting consequences for athletes and doctors. No previous studies have reported UEFA pre-participation screening results in semi-professional footballers. This study aims to further knowledge regarding ‘normal’ data in this population. Method Retrospective audit and analysis of records of pre-season medicals for all male first-team players at one semi-professional Northern Ireland Premiership team between 2009-2012. Medicals were conducted by the club doctor following the UEFA proforma. Height, weight, blood pressure (BP), full blood count (FBC), dipstick urinalysis and resting electrocardiogram (ECG) were conducted by an independent nurse. Only one ECG must be documented during a player’s career; other tests are repeated yearly. Results 89 medicals from 47 players (6 goalkeepers, 11 defenders, 22 midfielders and 8 attackers; mean age 25.0 years (SD 4.86)) were reviewed. Mean height of the players was 179.3 cm (SD 5.90) with a mean weight of 77.6 kg (SD 10.5). Of 89 urine dipsticks, 7 were positive for protein; all 7 were normal on repeat testing following 48 hours of rest. Of 40 ECGs (mean ventricular rate 61.2 bpm (SD 11.6)), one was referred to cardiology (right bundle branch block; prolonged Q-T interval). No players were excluded from participation. Conclusions This study provides important information about ‘normal’ values in a population of semi-professional footballers. Urinalysis showing protein is not uncommon but is likely to be normal on repeat testing.
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Affiliation(s)
- Neil Heron
- Department of General Practice and Primary Care, Queen's University, Belfast, Irelan.
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