The apparent on-ice heart attack or cardiac arrest of former Vancouver Giants hockey player Craig Cunningham begs the question: should recreational and elite athletes be screened for risks that may lead to such collapses, or worse, sudden death?
The Vancouver Giants and all Western Hockey League teams require prospects to undergo cardiac tests to be cleared for play, but it’s unknown whether Cunningham had any testing done in the past five years since leaving the Giants.
It’s also uncertain if the 26-year old Trail, B.C. native who now captains the Tucson Roadrunners, had any pre-existing conditions that could cause his collapse moments before last Saturday’s American Hockey League game against the Manitoba Moose. He received cardiopulmonary resuscitation (CPR) on the ice as well as en route to hospital. He was listed in critical condition Monday.
The entire issue of screening athletes for such tragic events is contentious because of the potential for false positives, costs and the rarity of problems found, but a two-year study done on B.C. athletes sheds new light on the best, most cost-effective methods to identify those with risk factors if indeed screening is desired by individuals or sports teams.
In the recently published Canadian Journal of Cardiology study, researchers at Vancouver General Hospital, UBC, Sports Cardiology B.C. and the Vancouver Coastal Health Research Institute, revealed underlying cardiac disease is rare.
Only half of one per cent of about 1,400 athletes had signs and symptoms that could lead to sudden cardiac death. Of seven athletes screened and found to have cardiovascular abnormalities, six had abnormal ECGs; the other athlete had a history of fainting, chest pain and palpitations that were later diagnosed as being related to a condition known as mitral valve prolapse.
Most sudden cardiac deaths in athletes occur by surprise since the majority of athletes who fall victim have no apparent prior symptoms.
Cardiologist Dr. Saul Isserow said most medical and sporting bodies agree that athletes should be aware of their personal and family medical history and undergo some testing before participation in elite competitive sports.
But there are no general Canadian guidelines for young athletes so the study in 12- to 35-year olds sought to understand the prevalence of risk factors and the most cost-effective way to evaluate players to identify abnormalities.
Researchers learned a refined questionnaire they developed was a highly effective screening tool when used in combination with ECGs.
Said Dr. James McKinney, a cardiologist and lead author: “The whole question of screening is a highly contested topic. Exercise is incredibly safe and there’s no disputing the tremendous health benefits of exercise.
“But I think as long as young athletes suffer sudden cardiac death, there will also be a question of how could this have been prevented. We believe our method of a more detailed questionnaire and an ECG is a feasible, practical method.”
In the study, the government cost of an ECG was under $15 but if a specialist physician (cardiologist) was also consulted after abnormalities were detected and further tests performed, the cost for a diagnosis and treatment plan rose to about $3,800. Local researchers are optimistic a new, much larger study being done in Britain will validate their approach and definitively answer the question: does screening save lives?
McKinney cautioned that ECGs in athletes may look different than those on non-athletes so interpretations of such tests should be done by experts.
Isserow agreed, saying screening can be a bit like opening Pandora’s Box; anxiety-provoking false positives and higher medicare costs may accrue if it’s not done properly. He suggests doctors refer athletes and other patients to the Sports Cardiology B.C. program at UBC Hospital which opened Monday.
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