A recent story about a 17-year-old Boy Scout who died suddenly during a 7.7-mile hike in Florida has everyone wondering what went wrong. Every time I see a story like this, where an unexplained death occurs in a young person - especially an otherwise healthy teenage athlete - it makes me wonder whether it's a good idea to have in-depth annual physicals performed on adolescents contemplating participating in high-endurance sports.
Most children get an annual physical as required by state law to attend school or play sports. I have three children, and for the most part, their physicals constitute a review of systems, blood pressure, weight and height documentation, vital signs and maintenance of vaccination schedules.
So the question is: Should adolescents have more in-depth assessments done to evaluate the status of their cardiovascular health?
This of course is a controversial question to ask because doctors can't seem to agree on what tests should be done. And with the swelling numbers of uninsured Americans and the escalating costs of preventive medicine not covered by insurers, we're immediately challenged with the dilemma of who's going to pay for cardiac testing, and what happens if we do find something wrong?
A perfect example of this is the current criticism of prostate cancer screening. Many studies are now suggesting that these screenings may lead to unnecessary procedures and negative side effects - that ultimately are ineffective in changing the course of the disease.
Now I can understand evaluating the effectiveness of prostate cancer screening versus cost and quality of life issues - especially because of the nature of the disease and the age group that it typically affects.
But when it comes certain heart diseases in the adolescent patient population, we're not looking at quality of life issues - but often, the difference between a life saved and a life lost.
One condition in particular that I think that teenagers should be screened for, is hypertrophic cardiomyopathy (HCM). This is a genetic condition that affects one out of 500 people and is the leading cause of heart-related sudden death in people under 30. And unfortunately, if it goes undetected, most parents only find out about HCM after their child dies on the field or court.
Hypertrophic cardiomyopathy is a condition in which the heart muscle becomes abnormally thick, making it harder for the heart to pump blood and sometimes interfering with its electrical rhythms. HCM tends to run in families, and children of parents with the genetic mutation for the disease have a 50 percent chance of inheriting it.
The reason HCM often goes undiagnosed, is because it rarely presents any noticeable symptoms. And while it can lead to severe cardiac problems at any age, but I would argue that if the condition is identified in the teenage population, proper monitoring could lead to a decrease in sudden, unexpected death among athletes.
Many states are looking into mandatory cardiovascular assessment of young athletes in an effort to identify patients at risk. Still cardiologists are not sure what the best method of screening should be - whether routine electrocardiography or echocardiograms prior to the start of the sports season would provide the most cost-effective, comprehensive data to aid in identifying athletes at risk.
I know that this debate will go on for quite a while, but I think that any parent with a teen or child participating in sports should have a conversation with their pediatrician.