It’s long been noted that the incidence of sudden cardiac arrest among young athletes is underreported. “Natural causes” is often listed for the unexplained sudden deaths of many high school and college students, though there is nothing natural about these seemingly healthy and young individuals dying—most of whom reportedly had never mentioned or exhibited any symptoms that would indicate a health issue.

Dr. Kimberly Harmon explains in an article in the Seattle Times that since there is no mandatory reporting of sudden cardiac arrest in the United States, it is unclear how frequent sudden cardiac arrest is. She then cites a recent study in Mayo Clinic Proceedings suggesting that the rate of sudden cardiac arrest and death is much higher than previously thought.

Tragic stories permeate the news, telling how a student collapsed—on a field, court, or track, in a classroom or hallway, or at home—and wasn’t able to be revived, but oftentimes no follow up on the cause of the collapse is given. Could it have been a heart condition that wasn’t detected? In so many of these cases, the heartbroken parents explain how their son or daughter was healthy, fit, and active with no prior medical conditions. They say the (multiple) physical evaluations their children had prior to participating in sports did not indicate any issues, and they were cleared to play.

Even the parents we have spoken with whose kids have been diagnosed with heart conditions say over and over again how the diagnosis took them by surprise because their child was extremely healthy with no symptoms or outward signs of their heart abnormality. In 80% of young athletes with a heart condition, according to Dr. Harmon, sudden cardiac arrest is the first symptom.

In looking at the sudden deaths of youths in the news this year, question marks on cause still remain for the majority. In North Carolina, a news outlet reported that Sharon Barker is still waiting to find out the cause of death for her son Aaron, a high school basketball player who collapsed and died at home in January. She says doctors suggest his death may have been caused by a heart abnormality, but her son never showed signs something was wrong (familiar scenario).

If we knew how frequent sudden cardiac arrest is among students, would schools be more apt to make sure their teams were tested prior to play? Would more parents be willing to get over the hurdle of potential cost to make sure their kids were safe?

Lawmakers in North Carolina have proposed a task force to study cardiac arrest among high school athletes in Senate Bill 538. If passed, data collected on the frequency of sudden cardiac arrest cases could help make the case for mandating heart testing for high school athletes in North Carolina.

Worthy of mention is the use of EKGs only in many free screenings available to students (with echocardiograms being performed only if an issue is detected on the EKG). EKGs are absolutely necessary to detect electrical heart abnormalities in young athletes, but echocardiograms are equally as necessary to detect heart conditions that cannot be identified on an EKG, such as the #2 cause of sudden cardiac death in young athletes—congenital coronary artery anomalies. Echoes have been able to pick up abnormalities in young athletes whose corresponding EKGs were normal and can either refute or confirm a diagnosis made from an EKG reading.

Sudden cardiac arrest is a real threat to young athletes, and schools, parents, and legislators are taking notice. But there is still a long road ahead to make sure all students have access to these important tests that can help keep them safe.

Wimbledon Athletics, the athletic testing division of Wimbledon Health Partners, provides on-site cardiovascular testing for high schools, colleges, universities, and sports facilities throughout the US to test student athletes for vascular conditions common to athletes and for cardiac abnormalities that can cause sudden cardiac arrest.

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