Posts Tagged ‘Sudden Cardiac Arrest’

Cardiac Screening in High School and College Aged Athletes

Friday, March 3rd, 2017

Beth Druvenga

Posted March 3, 2017

By Beth Druvenga, M.S. Ed, LAT, ATC

The inherent risk of injury when participating in some form of competitive athletics is widely accepted. Athletes suffer sprains, strains, concussions, fractures, contusions and lacerations to name a few injuries. A risk not so widely accepted is the risk of sudden cardiac arrest (SCA) or sudden cardiac death (SCD).

We have all seen the stories on the news or read the articles: A young athlete gone too soon. Athletes are in shape and generally in good health; they are not supposed to be participating one minute and unresponsive the next. As an empathetic, reasoning and rational culture, we cannot accept young lives being taken unexpectedly during athletic participation. But, it does happen. As an Athletic Trainer (AT) there is a list of potentially fatal events which may occur every day. I have to take a time out before games to internally review my emergency action plan (EAP), to prepare myself for the worst.

According to a 2011 study by Harmon et al., “SCD is the leading medical cause of death in NCAA athletes, is the leading cause of death during sport and exercise, and occurs at a much higher rate than previously accepted.”1 Hypertrophic cardiomyopathy and coronary artery anomalies account for 53 percent of all sudden cardiac deaths.2 Universally, professionals in the cardiac and sports medicine world alike have a common goal of preventing sudden cardiac death in athletes.4

To help prevent SCD, scientists and researchers have encouraged cardiac screening as a tool to detect underlying cardiac disorders and take the necessary steps for prevention. In fact, the Fédération Internationale de Football Association or International Federation of Association Football (FIFA) and the Union of European Football Associations (UEFA) have made cardiac screening mandatory before competition, and the International Olympic Committee encourages it as best practice.3 However, in the United States, only the National Basketball Association (NBA) mandates electrocardiograms (ECGs) or echocardiography annually.2

In Italy and Israel, it is required as part of a pre-participation examination (PPE) to have a cardiac screening.4 While in the United States a PPE involves a medical questionnaire and physical examination by a healthcare professional.2 And although the American Heart Association (AHA) supports pre-participation cardiovascular screening, it also acknowledges that it is not practical in mass context or nationwide mandate, due to the cost being an estimated 2 billion dollars per annum. Thus, the question remains. How do we move forward?

Until a nationwide, homogenous standard for cardiovascular screening is established for all high school and college aged athletes, take a look at some ways to combat SCA and SCD.

- Review your PPE questionnaire to confirm it includes questions the AHA supports for detection of potential cardiovascular disorders. Verify that these exams are being performed by a physician, nurse practitioner or physician assistant; someone who is trained and comfortable with detection of cardiovascular problems. According to the AHA, there is an increasing trend of states allowing chiropractors and naturopaths to perform PPE screenings, though they lack the cardiovascular screening training.2

- Review your facility’s EAP with not only your sports medicine staff but with people in the building who will be present when the EAP is put in to action. I am certain there are coaches and administrators who receive their EAPs but fail to read them and are not familiar enough to confidently put them into action.

- Get an automated external defibrillator (AED). I repeat, get an AED! Early defibrillation is essential during SDA to increase the chances of survival. If your school doesn’t have an AED, there are many grants and resources available to assist you in acquiring one.

- Consider providing cardiac screening for your school. There are many companies that perform cardiac screening, so reach out to your community and see what is out there. The most basic cardiac screening consists of a 12-electrode ECG which analyzes resting heart rhythm. This can help detect cardiac anomalies which may require further testing.

You, as an AT, are the best resource. Advocate for your athletes. I know ATs who have lost a student athlete to SCD. My hometown lost a student athlete to SCD during a wrestling tournament a little over a year ago. It all begins with YOU. Do your research to help prevent SCD and protect your athletes. Below are resources for cardiac screening and resources for AED grants, and I urge you to utilize them.

Cardiac Screening Resources

Parent Heart Watch:

AED Resources

Sudden Cardiac Arrest Foundation:


1. Harmon, K., Asif, I., Klossner, D., & Drezner, J. (2011). Incidence of Sudden Cardiac Death in National Collegiate Athletic Association Athletes. Circulation, 1594-1600.

2. Maron, B., Thompson, P., Ackerman, M., Balady, G., Berger, S., Cohen, D., et al. (2007). Recommendations and Considerations Related to Preparticipation Screening for Cardiovascular Abnormalities in Competitive Athletes: 2007 Update. Circulation, 1643-1655.

3. Schmied, C., & Borjesson, M. (2013). Sudden cardiac death in athletes. Journal of Internal Medicine, 93-103.

4. Steinvil, A., Chundadze, T., Zeltser, D., Rogowski, O., Halkin, A., Galily, Y., et al. (2011). Mandatory Electrocardiographic Screening of Athletes to Reduce Their Risk for Sudden Death: Proven Fact or Wishful Thinking? Journal of the American College of Cardiology, 1291-1296.

About the Author

Beth Druvenga is an Athletic Trainer currently living in northern Virginia. She has experience working in both a collegiate and high school setting. Druvenga is originally from Iowa where she earned her Bachelor of Arts degree in Athletic Training from Central College in 2012. She graduated from Old Dominion University in 2014 with a Master of Science in Education. Her professional interests include patient-reported outcomes, psychology of injury and rehabilitation as well as using yoga to increase flexibility.





Matters of the Heart

Monday, February 3rd, 2014

In September 2012, Athletic Trainer (AT) Caroline Oakley was substituting at Villa Maria Academy High School in Malvern, PA for a full-time AT, when she was faced with a medical emergency.  A cross-country athlete with no family history of a heart condition went into cardiac arrest.  When summoned by a teacher, Caroline was able to swiftly grab the AED (Automated External Defibrillator) from the athletic training facility while a parent spectator, who also happened to be an ER nurse, stepped up as a first responder.  When Caroline reached the athlete, there was no pulse, and they immediately applied the AED.  The AED advised the initial shock, then a second shock and, finally, resumed CPR.  The athlete’s pulse returned; by then, EMS had arrived on the scene.  Today that student athlete is alive and well as a result of the actions taken by Caroline that day.

February is American Heart Month, an entire month devoted to raising awareness about heart health through education and disease prevention. Currently, heart disease is the leading cause of death among men and women in the United States, and Sudden Cardiac Arrest (SCA) is the leading cause of death among young athletes.  The public may ask, why is this awareness so important since the traditional AT treats an athletic population? Not only do ATs treat the athlete, we are often interacting with the mature referee or spectator in the sports arena, as well as a range of ages and fitness levels in clinics and industrial settings. One day you may find yourself reacting as a first responder and in the position to save a life.

“In the fields of observation, chance favors only the prepared mind.” –Louis Pasteur

We all hope that, if faced with similar scenarios, we will know what to do, react the way we were trained and that we, too, will have positive outcomes.  Take a moment to evaluate your site by asking yourself the following questions. 

  1. Have you rehearsed your Emergency Action Plan (EAP) lately, and do you perform it regularly? (It is important that when the time comes, the steps are implemented properly).
  2. Do you have multiple EAPs for your various venues – the gymnasium, football field, swimming pool, etc.?
  3. Do you have an adequate number of AEDs readily accessible to you and other potential first responders?
  4. Do you require routine heart screenings as part of your pre-participation physical, which is an expensive and currently debated endeavor?
  5. Have you reviewed your CPR/AED skills recently?

According to the American Red Cross (ARC) Scientific Advisory Council, CPR skill retention begins to decline within a few months after a participant is trained. They recommend that you review every 3 months to keep your knowledge and skills sharp.  Check out the American Red Cross Refresher Center website for free online challenges that will help you feel ready to respond in the event of an emergency.

Check out the following links for more information relating to this topic:

 Tell us something you have done that could help your fellow AT in the event of a cardiac emergency.

 Do you require pre-participation heart screenings on your athletes?  Why or why not?

 National Athletic Trainers’ Association (NATA) members can read the November 2013 NATA News, Lifesaver Edition for more examples of heroic actions of ATs. Remember to wear your red for National Wear Read day to kick-off American Heart Month on Friday, February 7th.  

Written By:

Jennifer Striggle-Young, MEd, LAT, ATC