Cardiac Screening For Youth Sports

You may have seen news stories about seemingly healthy young athletes collapsing on the court or playing field. Sudden cardiac arrest in a child is a scary thought for any parent. What can you do to help keep your young athlete safe?

Most kids who play sports aren’t at increased risk for cardiac arrest, says Michael R. Carr, MD, attending physician in cardiology at Lurie Children’s. But kids with some heart conditions or differences in their heart’s structure (congenital heart defects) may be at higher risk for cardiac arrest. The extra physical effort and exertion of playing high school sports or sports at advanced levels can also increase risk in certain kids, Dr. Carr adds. 

Cardiac screening for sports can help you learn if your child may have a heart condition. Here, Dr. Carr tells parents how congenital heart defects and other forms of heart disease may affect kids and why cardiac screening is important.

What is cardiac arrest?

Cardiac arrest, also called sudden cardiac arrest, causes the heart to stop functioning as it should and can make you lose consciousness. Cardiac arrest is an emergency that requires immediate medical treatment. Delays in treatment can lead to sudden cardiac death. While sudden cardiac death is rare, about one in 100,000 children under 18 die from it each year in the U.S.   

What is a cardiac screening test for athletes?

Cardiac screening for athletes typically includes specific questions about your child’s health history and family history of cardiac conditions or sudden cardiac death. Screening also includes a complete physical exam. 

Who performs cardiac screening?

A regular check-up by a pediatrician can usually confirm that young children are healthy enough for sports. Routine physicals also typically meet cardiac screening needs for elementary and middle-school kids who play sports. Most states require high school athletes to have a preparticipation evaluation, or sports physical, to participate in a sport.

Sports physicals for kids may take place at their healthcare provider’s office or another licensed healthcare facility. Additional cardiac screening tests may be part of routine sports physicals at some healthcare facilities.

What happens during cardiac screening?

Your child’s healthcare provider should perform a 14-point cardiac screening recommended by the American Heart Association or some variation of that screening. They typically ask about family members who have, or had, heart disease and those who experienced sudden cardiac death. They may also ask if a healthcare provider has ever told your child they can’t play sports for any reason.

A provider will check your child’s blood pressure. They also listen to your child’s heart to see if they hear sounds that indicate changes in blood flow (heart murmur) or abnormal heart rhythms. They should ask if your child experiences or has ever experienced:

• Chest pain or pressure during exercise
• Fainting (syncope) or feeling like they’re going to pass out
• Fatigue
• Heart flutters (palpitations)
• Shortness of breath

Cardiac screening sometimes reveals that a child may have a heart condition. “Preparticipation evaluation screens kids for cardiovascular risk,” says Dr. Carr. “Providers may refer your child to a heart specialist (cardiologist) for further testing or an expert opinion before your child plays a sport.”

Is an electrocardiogram part of cardiac screening for sports? 

An electrocardiogram (ECG or EKG) is a common test providers use to determine the health of the heart’s electrical system. It measures heart rate and heart rhythm. It can also tell providers whether the heart muscle has damage.

ECG for athletes is not usually part of cardiac screening. But kids with known heart conditions often have ECG testing as part of their regular cardiac care. These and other tests help cardiologists determine the risk of participating in sports for these specific kids, Dr. Carr says. 

What increases cardiac arrest risk in athletes? 

Certain heart conditions may increase a young athlete’s risk of a cardiac event, says Dr. Carr. These conditions include:

Arrhythmias

Arrhythmias are differences in the way your heart beats. Changes in the rate or rhythm of your child’s heartbeat can change how blood flows through their heart. Arrhythmias can cause:

• Chest pain
• Dizziness
• Fainting
• Palpitations
• Shortness of breath

Talk to your healthcare provider if your child has symptoms that may indicate a cardiac arrhythmia. Your provider may recommend further testing to determine if it’s safe for your child to participate in sports.

Acquired Heart Disease

Myocarditis occurs when the heart becomes inflamed, often after a viral infection. The condition damages the heart muscle and causes problems with how the heart pumps blood.

Congenital Heart Disease and Congenital Heart Defects

Some children are born with conditions that affect their heart’s health (congenital heart disease) or develop changes to their heart due to genetic differences. These conditions include differences (defects) in their heart’s structure that change how blood flows to their lungs and throughout their body. These differences may also cause changes to the heart’s function. Some kids with congenital heart disease have symptoms when they’re young, but some kids aren’t diagnosed until they’re older.

What are the most common heart conditions in young athletes? 

The most common heart conditions that affect kids who play sports include:

• Cardiomyopathy
• Coronary artery anomaly

“Hypertrophic cardiomyopathy is the most common finding in sudden cardiac death in young athletes in the U.S.,” says Dr. Carr. “Congenital coronary abnormalities generally are the second most common, followed by myocarditis.”

Does sport type matter in determining cardiac arrest risk in kids? 

Most kids without an underlying heart condition aren’t at higher risk of cardiac arrest because they play certain sports. However, cardiologists consider the type of sport a child wants to play when they have a known heart condition. 

A hard hit directly to the chest may increase the risk of cardiac arrest in athletes who have certain heart conditions. However, the 2023 incident involving NFL player Damar Hamlin demonstrates that even healthy athletes can experience a sudden cardiac arrest with a direct hit to the chest (commotio cordis). Dr. Carr says it’s important to discuss risk when kids with heart conditions want to play football, hockey or other contact sports. 

Cardiac Symptoms in Kids Who Play Sports

All kids who play sports may experience occasional chest pain or fatigue. These symptoms don’t always indicate a heart condition, especially if they happen once or are explainable. Your child may not have their usual stamina or may feel fatigued during practice if they’ve recently had a respiratory or other viral infection, but these symptoms should improve over time. That’s different from a steady decrease in exercise tolerance over time, Dr. Carr says.

If your child has consistent symptoms associated with exercise or activity, and there’s no clear reason for them, check in with their healthcare provider. A provider should check your child if they have frequent chest pain, palpitations or shortness of breath. Passing out during activity always requires further evaluation. 

What You Can Do To Protect Your Child

Dr. Carr says the risk of sudden cardiac death in most children remains very low and the benefits of an active lifestyle and being a member of a team are important. “One in 100,000 kids is a small number, but it’s absolutely too many,” he says. Parents can help keep kids safe by ensuring schools and sports facilities have action plans if an athlete experiences a cardiac event. 

“Action plans should include access to automated external defibrillators (AED) and people who have training in CPR,” he says.

Learn more about pediatric cardiology at Lurie Children’s.

Search our blog Search

---