(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:
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| 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
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