Electrocardiography as a screening tool for hypertrophic cardiomyopathy in healthy athletes

Problem: Sudden cardiac death in young athletes is very tragic due to the young age of the athlete and their often perceived level of remarkable health. Though these cases may seem rare, they pose a significant public health problem that must be addressed. In young athletes under 35 years old, hypertrophic cardiomyopathy (HCM) is the most common cause of sudden cardiac death (SCD). In an attempt to identify athletes with HCM or other fatal cardiac abnormalities, the American Heart Association (AHA) and the European Society of Cardiology (ESC) have established preparticipation screening standards for competitive athletes. The AHA recommends only a history and physical while the ESC recommends a 12-lead electrocardiogram (ECG) along with a history and physical. This difference remains a highly debated topic today. Methods: Original studies were compiled by using the Weill Cornell Medical College (WCMC) Library Website portal. PubMed was used as the primary search engine. Search terms used were 'hypertrophic cardiomyopathy AND screening' and 'hypertrophic cardiomyopathy AND ECG'. Results: Four original studies and two review articles were used for this literature review. These studies demonstrate that either ECG is more sensitive and specific in detecting cardiac abnormalities than history and physical alone or that after the introduction of a standard screening protocol which includes ECG, the incidence of SCD related to HCM and other cardiac abnormalities was significantly decreased. Conclusions: Similar research designs with physician assistants in vital roles in screening athletes can help to determine if they can reduce the cost of implementing ECGs in preparticipation screening programs.