The feasibility of routine ECG screening of athletes?

(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