geoffrey modest medical blogs

a recent article looked at the demographics and epidemiology of sudden death in young athletes from the United States National Registry from 1982-2011 (see athlete sudden death etiology ajm2016 in dropbox, or Maron BJ. Am J Med (2016) 129, 1170). Details: -- 2406 athlete deaths were reported to the registry, of whom 842 had confirmed cardiovascular causes associated with exercise, and with autopsy examination. Results: -- Mean age 18, 89% male, 46% white/43% African-American or other minority. 25% of deaths were during competition, 39% during practice, 17% during recreational activity, 18% unassociated with physical activity. 66% were junior high or high school, 19% in college. 35% playing basketball, 30% football. -- Mortality rate in males exceeded females by 6.5-fold (1:121,691 and 1:787,392 athlete-years, respectively; p <0.001) -- cause of sudden death:    -- hypertrophic cardiomyopathy (HCM): 302 athletes (292 males, 10 females), 36% of cas...

the American Heart Assn and Am College of Cardiol (and endorsed by Am College of Sports Medicine) just published guidelines on EKG screening in healthy 12-25 year olds (see athletic screening ekg AHA 2014 in dropbox, or DOI: 10.1161/CIR.0000000000000025​). most of the data are from studies on screening young people in competitive athletic programs, with the goal to decrease sudden death, a rare but clearly bad outcome. as noted in prior blogs, there is a significant difference in the different recommendations: the European Society of Cardiol has recommended national EKG screening initiatives of athletes based on studies there (positive in Italian study, though not replicated in an Israeli one), but the AHA has consistently been against them (prior blogs have detailed the reasons, including the fact that the most common cause of athlete-associated sudden death in Veneto Italy, the site of the most positive intervention study, is from a specific genetic...

this issue of NEJM has an article on role of cardiac screening pre-sports participation (see  athlete screening preparticipation nejm 2013  in dropbox, or DOI: 10.1056/NEJMclde1311642. article presents differing views on the appropriate extent of screening, esp whether to use EKG as part of the screen, noting that: --not common (around 100-150 young athletes die/yr in US), pales in comparison to numbers of youth who die from accidents, homicide, suicide, and even non-exercise assoc sudden death --still obviously a very tragic event when it happens, typically unsuspected in apparently totally healthy, vigorous person --everyone agrees to do pre-athletic screen with history/physical, best with standardized screen, assessing cardiac history of family and patient (eg   dizziness,  fainting, chest pain, shortness of breath and  palpitations during or after exercise, or a change  in exercise tolerance).  but family history only picks up 16% and ...