Student Well-Being

Cardiac-Related Student Deaths Raise Questions About Screenings

By John Gehring — October 25, 2000 4 min read

Steven “Scotty” Lang had passed a routine physical before joining the football team at Fountain Valley High School in Orange County, Calif., last year, but a heart ailment called hypertrophic cardiomyopathy went undetected. One day in practice, the 16-year-old collapsed and died.

Last month, a new foundation took a significant step toward preventing any more of the school’s students from suffering that fate by providing free heart tests to all of Fountain Valley’s athletes. Some 1,200 student athletes from 10 Los Angeles-area schools will receive the tests next month.

“If Scotty would have had this test, it would have showed a thickening of his heart,” said Seaneen Greaves, who started the A Heart for Sports Foundation six months ago. Her husband has the same condition that killed Scotty Lang. “You cannot treat something you do not know you have.”

Such efforts reflect a growing concern among some doctors and school athletic associations that more needs to be done to prevent sudden cardiac-related deaths of student athletes. While such deaths are rare—studies estimate that only about one in every 200,000 high school athletes dies suddenly from cardiac arrest each year—that fact provides little consolation to the families and friends of those stricken.

Last month, a junior on the St. Clair County High School football team in Odenville, Ala., died of heart failure during the opening kickoff of a game. Earlier this month, a 14-year-old student in Boston who had passed his physical died after his heart stopped while he ran a lap during football practice.

“There is a message here: These are people who didn’t have to die,” said Dr. Robert Myerburg, the director of the cardiology division at the University of Miami’s school of medicine.

He believes the use of an electrocardiogram, or EKG, would be a big improvement over the physicals that most students currently receive, maintaining that such tests could help identify about 70 percent of the conditions that cause sudden death in young athletes.

“It would not be perfect, but it would be far ahead of where we are now,” Dr. Myerburg said.

There are no national standards for student-athlete physicals, according to Bruce Howard, the communications director of the National Federation of State High School Associations, based in Indianapolis. While passing a physical is a standard part of eligibility for playing a sport, he said, individual schools set their own guidelines for those exams.

At some schools, athletes meet in the gymnasium, where they make stops at different stations set up to evaluate everything from vision to knee problems. Other schools expect students to make their own arrangements for receiving the exams.

Necessary Test?

One of the main obstacles to providing EKGs to all student athletes is the cost involved.

The test can cost $50 to $70 per person if conducted in a hospital, Dr. Myerburg said, though he added that the figure could be reduced to as low as $10 if schools adopted such testing as a policy and worked out a contract deal with hospitals.

Dr. Richard Luceri, the director of the arrhythmia center at Holy Cross Hospital in Fort Lauderdale, Fla., offers free EKG screenings to students. “In Italy, these exams are mandatory for high school students,” he said. “This is a simple test that can absolutely save lives.”

Another reason school boards have been reluctant to use the tests, beyond the expense, Dr. Luceri said, is that they fear being held liable if a student passes an EKG and then dies of a cardiac problem that should have been detected.

But other physicians argue that a thorough physical can be done without an EKG or other heart tests, which sometimes produce “false positives” that show a problem when there is none.

“There are very few cases of cardiac disease so severe that they can lead to sudden death that can’t be picked up by doing a patient history and a thorough physical exam,” said Dr. Bill Howard, the director of the sports- medicine center at Union Memorial Hospital in Baltimore. “There are kids who die of cardiac disease caused by a viral infection, for example, that an EKG wouldn’t pick up.”

At least one state legislature has considered tightening the rules on student physicals.

Florida Rep. Eleanor Sobel, a Democrat, introduced a bill last spring that would have required all student athletes to receive EKGs and undergo exams performed by medical doctors.

“Optometrists or chiropractors can do these exams now,” she said. “We are trying to raise the standard. The physicals can be more thorough.”

The bill passed the Florida legislature’s House education committee last April, but went no further. Ms. Sobel plans to reintroduce the measure next year.

‘Hit or Miss’

Meanwhile, the Florida High School Athletic Association for the first time this year began requiring all state schools to use a standard preparticipation form that makes sure students are questioned about their medical histories and that medical doctors are signing off on the exams.

“It was hit or miss before,” said Ronald Allen, the Florida group’s associate commissioner for athletic operations.

Physicians on the association’s sports advisory committee voted not to recommend the use of heart tests, he added, because of questions about the cost and accuracy of medical assessment.

But in California, A Heart for Sports Foundation hopes to make cost a less prohibitive factor. The group is using a new hand-held device patented by SonoSite, a Bothell, Wash., company. The SonoHeart costs about $25,000, compared with $150,000 for a traditional EKG machine.

“We want to bring this to every school district in the country,” Ms. Greaves said.

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