(For those seeking in-depth detail and a comprehensive bibliography of sources, this month’s Heart Rhythm Journal featured a number of enlightening papers on this controversial topic.)
Although in the past I have written about the folly of the inguinal hernia exam as part of a sport’s physical; the heart of the matter–detecting a life-threatening cardiac pathology–is quite serious.
I had prepared a lengthy ‘bullet-point’ list as to why the seemingly no-lose proposition of adding an ECG to the routine history and physical exam would not work in the real-world of American healthcare.
But I found a better way to illustrate said quandary. With pictures, of course.
If widespread screening were instituted, here is a prototypical ECG:
Here is the same ECG before I photoshopped out the computer interpretation:
 |
| Note the “ACUTE MI” designation. |
This bike racer was not having chest pain. Nor does his asymptomatic resting heart rate of 43 require a pacemaker.
Just for grins, I showed this nameless ECG around. Most eyes were immediately drawn to the provocative but incorrect computer diagnosis. (Imagine if the same ECG was done in an emergency room for a case of musculo-skeletal non-cardiac chest pain.)
These days, in our present healthcare climate, making a diagnosis of ‘normal’ is increasingly difficult. In cardiology matters, saying to a patient, “you are normal…no further testing is required” often entails a hefty dose of radiation or ultrasound waves. That is, unless the doctor has sound judgment, and guts.
Multiply this ECG scenario by millions of young athletes screened.
Ouch.
JMM
Related posts:
{ 2 comments }
Thank goodness SOMEONE recognizes athletes' bodies may be different. Although it is comforting to have a normal or a standard to compare a sample to, maybe research could involve establishing a few variations of the already accepted norm. My favorites being: the active person's norms versus the sedentary person's norms.
Enjoyed reading this post.
I'm asked week-in and week-out about screening exams and tests for adult athletes.
What do YOU recommend for the seemingly healthy 25-45 year old male non-elite athlete who asks about screening? Annual physical? Any lab tests? ECG? Echo?
It obviously takes you just a moment to conclude that the "abnormal" ECG above is okay for an athlete, but I do realize that your expertise is not available to the millions of athletes out there in any efficient manner.
I think this is a difficult issue.
Comments on this entry are closed.