Can an EKG prevent sudden cardiac death in an athlete? A systematic review

Background: Current U.S. recommendations for pre-participation screening do not include EKG. European protocol recommends EKG as part of screening and Italy has followed this standard since 1982. Five cardiac abnormalities, hypertrophic cardiomyopathy, coronary artery anomaly of wrong sinus origin, myocarditis, arrhythmogenic right ventricular cardiomyopathy, and ion channelopathies, are the most prevalent causes of sudden cardiac death in the U.S. Most of these cardiac abnormalities display intermittent EKG abnormalities. An athlete may have an abnormal EKG without any family history, symptoms, or physical exam findings of a cardiac abnormality. Could implementation of screening EKG with pre-participation physical exams for athletes uncover these abnormalities, therefore decreasing the number of sudden cardiac deaths during physical activity per year? Hypothesis: An EKG can contribute to the pre-participation physical for athletes by detecting certain cardiac abnormalities that lead to sudden cardiac death. Study Design: Systematic review of medical trials. Methods: Exhaustive search of databases including Ovid Medline, Pubmed, Cinahl, and Evidence-Based Medicine Review Multifile. Results: Five studies were found that evaluated the correlation between abnormal EKGs in athletes and the diagnosis of a cardiac abnormality that will cause sudden cardiac death. Only one study evaluated all participants with an echocardiogram as well as an EKG. A likelihood ratio of 3.04, sensitivity of 73%, and specificity of 76% was calculated using the information from this study. Conclusion: Studies evaluated did not make a large impact on the diagnosis of hypertrophic cardiomyopathy or other cardiac abnormalities by EKG. However, cardiac abnormalities that cause sudden cardiac death were found with EKG alone, when history and physical exam findings were normal. EKGs should be incorporated into pre-participation screenings to prevent sudden cardiac death. Degree Type Capstone Project Rights Terms of use for work posted in CommonKnowledge. This capstone project is available at CommonKnowledge: http://commons.pacificu.edu/pa/155 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use. If you have received this document through an interlibrary loan/document delivery service, the following terms of use apply: Copyright in this work is held by the author(s). You may download or print any portion of this document for personal use only, or for any use that is allowed by fair use (Title 17, §107 U.S.C.). Except for personal or fair use, you or your borrowing library may not reproduce, remix, republish, post, transmit, or distribute this document, or any portion thereof, without the permission of the copyright owner. [Note: If this document is licensed under a Creative Commons license (see “Rights” on the previous page) which allows broader usage rights, your use is governed by the terms of that license. ] Inquiries regarding further use of these materials should be addressed to: CommonKnowledge Rights, Pacific University Library, 2043 College Way, Forest Grove, OR 97116, (503) 352-7209. Email inquiries may be directed to:. copyright@pacificu.edu This capstone project is available at CommonKnowledge: http://commons.pacificu.edu/pa/155 NOTICE TO READERS This work is not a peer-reviewed publication. The Master’s Candidate author(s) of this work have made every effort to provide accurate information and to rely on authoritative sources in the completion of this work. However, neither the author(s) nor the faculty advisor(s) warrants the completeness, accuracy or usefulness of the information provided in this work. This work should not be considered authoritative or comprehensive in and of itself and the author(s) and advisor(s) disclaim all responsibility for the results obtained from use of the information contained in this work. Knowledge and practice change constantly, and readers are advised to confirm the information found in this work with other more current and/or comprehensive sources. The student authors attest that this work is completely their original authorship and that no material in this work has been plagiarized, fabricated or incorrectly attributed.