{"id":28704,"date":"2012-05-03T08:21:01","date_gmt":"2012-05-03T12:21:01","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=voices&p=28704"},"modified":"2012-05-03T08:43:13","modified_gmt":"2012-05-03T12:43:13","slug":"the-dark-side-of-ekg-screening-in-athletes","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2012\/05\/03\/the-dark-side-of-ekg-screening-in-athletes\/","title":{"rendered":"The Dark Side of EKG Screening in Athletes"},"content":{"rendered":"

<\/em>CardioExchange welcomes this guest post from\u00a0Dr. Westby Fisher, an electrophysiologist practicing at\u00a0NorthShore University HealthSystem in Evanston, Illinois, and a Clinical Associate Professor of Medicine at\u00a0University of Chicago\u2019s Pritzker School of Medicine.\u00a0This piece originally appeared on his blog,\u00a0Dr. Wes<\/a>.<\/em><\/p>\n

They sat nervously with their son in the doctor\u2019s office, wondering why they were there. John was, after all, the picture of health and had just received a scholarship to Stanford University to play soccer. His mother and father had been to every soccer match throughout his formative years, enduring the travel schedule with its weekends away from home, long hours, horrible weather. John was staring at his iPhone, his mother clutching a Kleenex. John\u2019s father stared out the window. It was raining.<\/p>\n

The door opened.<\/p>\n

\u201cHello, I\u2019m Dr. Kiljoy. They asked me to see your son about a finding on his EKG.\u201d<\/p>\n

\u201cHello,\u201d they\u00a0said back.<\/p>\n

\u201cAs\u00a0you know, we\u2019ve been looking into EKGs in athletes because we have suspected\u00a0for some time that an EKG will help us better detect students who might be at risk for sudden cardiac\u00a0death while participating in sports. You know,\u00a0even if we can prevent one death in these young people,\u00a0it would be worth it. None of us want a young person to die. That\u00a0New York Times<\/em>\u00a0article yesterday<\/a>\u2026 dang\u2026 with that crying family and all right there at the top\u2026 poor boy collapsed, people had no clue what happened at first, people thought he overheated, then waited\u2026 only later did they find that AED. Then it didn\u2019t work \u2019cause the battery was dead. So sad! We really are trying to prevent that from ever happening. Seriously. Sad as hell. And to think we could have caught this if that teenager had just had an EKG\u2026\u201d<\/p>\n

\u201cYes, of course!\u201d said John\u2019s mother. \u201cI\u2019m SO glad you did this! We\u2019ll be so reassured to know that John\u2019s going to be okay.\u00a0\u201d<\/p>\n

A pause filled the room\u2026<\/p>\n

\u201cHe IS going to be okay, isn\u2019t he?\u201d she asked.<\/p>\n

\u201cWell, Mrs. Smith, we\u2019re not sure, we have to run some other tests. You see, he had a slight elevation to his ST segments in these leads here, see? Then look at his heart rate, it\u2019s so slow! And that voltage here, it\u2019s more than we usually see\u2026 It\u2019s probably okay, but I\u2019m going to order an echo to look at his chamber sizes.\u201d<\/p>\n

\u201cOkay\u2026\u201d<\/p>\n

\u201cAnd then I\u2019m going to have one of our EP people see him to make sure he doesn\u2019t have a congenital ion channel disorder\u2026\u201d<\/p>\n

\u201cA what?\u201d<\/p>\n

\u201cA channelopathy\u00a0\u2014 a genetic defect of some ion channels in his heart \u2013 the most common form is called Brugada Syndrome\u2026\u201d<\/p>\n

\u201cHow do you spell that?\u201d She waited with pen and paper to jot it down\u2026<\/p>\n

\u201cB-R-U-G-A-D-A. Look, he\u2019s probably okay, but we want to be absolutely sure, especially with that ST segment elevation in those leads\u2026\u00a0\u00a0We\u2019ll also check a stress test to make sure his heart rate comes up appropriately with exercise and that there aren\u2019t any funny EKG changes with exercise that might suggest an anomalous coronary artery \u2013 I\u2019ve seen three people die like a dog with that one!\u201d<\/p>\n

\u201cHow often does that happen?\u201d she asked.<\/p>\n

\u201cWell, it\u2019s pretty uncommon, but if it\u2019s there, sometimes we have to do open heart surgery to reimplant it so that\u00a0it won\u2019t get pinched between the pulmonary artery and aorta when he exercises.\u201d<\/p>\n

\u201cBut he\u2019s never had a problem! And no one has ever died suddenly in our family \u2013 ever!\u201d<\/p>\n

\u201cMrs. Smith. Remember why we\u2019re doing this: John\u2019s safety. This is\u00a0all<\/strong><\/em>\u00a0about John\u2019s safety.\u201d<\/p>\n

\u201cAnd if you find something in all these tests, then what?\u201d<\/p>\n

\u201cWell, he wouldn\u2019t be able to play soccer.\u201d<\/p>\n

John\u2019s eyes suddenly lift from his cell phone. \u201cWhat did you say?\u201d he asked.<\/p>\n

\u201cYou won\u2019t be able to play soccer,\u201d Dr. Kiljoy repeated.<\/p>\n

\u201cMom, what the f#$*!? If I don\u2019t play soccer, I don\u2019t go to Stanford. If I don\u2019t go to Stanford, I\u2019ll never play soccer again! Are you serious?\u201d<\/p>\n

The father, sensing his son\u2019s concern, returns to the room from his window transcendental meditation.<\/p>\n

\u201cSon, let\u2019s just get the tests. Your mother\u2019s concerned.\u201d<\/p>\n

\u201cMom\u2019s concerned? What the hell do you mean \u2018Mom\u2019s concerned?\u2019 What about me? I never wanted to get this frickin\u2019 EKG anyway! Look, I\u2019m FINE. I never so much as farted wrong. We have no family history of heart disease. I\u2019ve never felt my heart race, I\u2019ve never passed out, I\u2019m faster than everyone else on my\u00a0team and we just won the State Championship! How\u2019s THAT for a stress test? I\u2019ve worked my ass off for YEARS to get this scholarship. And now, just because of this EKG with bull—- findings that don\u2019t pertain to kids my age they\u2019re going to do a million tests just to be sure? Seriously? Honestly, Dad, you gotta be kidding me\u2026 How much is all this gonna cost, huh? And maybe I\u2019ll lose my scholarship, too? How much is THAT worth?\u201d<\/p>\n

\u201cJohn, honey, it\u2019s for your safety,\u201d his mother whispers, tears streaming down her cheeks. \u201cWe love you so. We just don\u2019t want anything bad to happen to you\u2026\u201d<\/p>\n

\u201cYour Mom\u2019s right, John. We just want to be sure\u2026 Really\u2026\u201d Dr. Kiljoy continued.<\/p>\n

John looked up at Dr. Kiljoy, and said slowly, painfully, with tears in his eyes:<\/p>\n

\u201cDoctor, f*&% you.\u201d<\/p>\n

-Wes<\/p>\n

P.S.: For more, please see\u00a0Dr. John M\u2019s take<\/a>\u00a0on the\u00a0New York Times\u2019<\/em> abysmal reporting\u00a0on this issue.<\/p>\n","protected":false},"excerpt":{"rendered":"

The New York Times’ “abysmal” report on screening young athletes for heart risk prompts Wes Fisher to envision how such a misguided recommendation could affect athletes and their families.<\/p>\n","protected":false},"author":1177,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[1089,1249,897],"class_list":["post-28704","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","tag-athletes","tag-ecg-screening","tag-sudden-cardiac-death"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/28704","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/1177"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=28704"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/28704\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=28704"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=28704"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=28704"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}