13-year old Patrick remembers a recent wrestling match going well. Then suddenly, he began having chest pains.

“I just really exerted myself you know and I almost went to the floor and had trouble breathing,” he remembers.

Patrick saw his doctor and then a specialist who took a closer look at his heart.

Each year, about a dozen seemingly healthy young athletes die of sudden cardiac arrest- a relatively rare occurrence- but nonetheless tragic.

“What we hope to do is pick up some of the kids that have underlying cardiac problems or other health problems that could lead to serious injury or death and prevent those,” explains Dr. John Stevens, a pediatric cardiologist with Children’s Healthcare of Atlanta.

Experts say the key is catching kids before they hit the field with thorough sports evaluations that include physical exams and comprehensive questions about family history.

“Have there been activity or sports related deaths? Are there any cardiac problems that run in the family? Unfortunately for cardiac causes of sudden death, many times the physical exam, in fact most of the time, the physical exam is normal, so the historical information is much more important.”

The problem is sports evaluations vary by state and aren’t always thorough. That’s why some health officials are recommending screenings that meet one national standard.

Dr. Stevens helped author a standard form in his state. There were previously 90-various forms.

“There’s not good data to say these forms have made an impact but there certainly are athletes who are being disqualified from sports that have potentially serious cardiac problems.”

As it turns out, Patrick’s heart is just fine, and he’s now clear to go back to the mat.

• An estimated 36 percent of adolescent athletes with cardiac anomalies die of hypertrophic cardiomyopathy, in which the heart muscle becomes excessively thick.
• Coronary artery abnormalities account for 19 percent of adolescent athlete fatalities.
• Increased cardiac mass accounts for 10 percent of adolescent athlete fatalities.
• Estimated sudden death rates are five times higher in male athletes than in female athletes.
• Estimated sudden death rates are two times higher in male college athletes than in male high school athletes.
• Most sudden deaths occur in male football and basketball athletes.

If athletes must pass a physical health exam before being allowed to participate in sports activities, why do certain conditions still go unrecognized? According to the American Heart Association (AHA), many cardiac conditions can be present with or without symptoms, making them difficult to detect. Although an electrocardiogram (EKG) can identify such health defects, the screening tool is not used during a routine sports physical unless the physician has reason to believe a cardiac problem may exist.

You can expect the following procedure when your child’s physician performs a pre-participation physical exam, according to the American College of Sports Medicine:

• The physician will inquire about your child’s past medical history, including any allergies he or she suffers, medications he or she takes and any other medical conditions your child has now or has suffered in the past.
• The physician will inquire about your child’s sport-specific history, including any orthopedic injuries (sprains or fractures), dental trauma, chest pain with exercise, fainting spells, excessive shortness of breath or fatigue with exercise, etc.
• The physician will inquire about your child’s family history, specifically addressing heart disease, high blood pressure, diabetes and unexpected death before the age of 50.
• The physician will perform a physical exam during which your child’s pulse rate, blood pressure rate, height, weight, vision and hearing are monitored.

After a thorough history and physical exam, the physician will make a participation decision by answering the following questions:

• Does a problem exist that places the athlete at increased risk of injury?
• Is any other participant at risk of injury because of this problem?
• Can the athlete safely participate with treatment of the problem?
• Can limited participation be allowed while treatment is initiated?
• If clearance is denied for certain activities, in what activities can the athlete safely participate?
• Is consultation with another healthcare provider necessary to answer the above questions?

While you cannot prevent all sports injuries and deaths from occurring, you can take several steps to minimize your young athlete’s risk of injury. The SafeUSA initiative offers the following guidelines to help keep your young athlete safe:

• Before your child starts a training program or enters a competition, take him or her to the doctor for a physical exam. The doctor can help assess any special injury risks your child may have.
• Make sure your child wears all of the required safety gear every time he or she plays and practices. Know how the sports equipment should fit your child and how to use it. If you are not sure, ask the coach or a sporting goods expert for help. Set a good example: If you play a sport, wear your safety gear, too.
• Insist that your child warm up and stretch before playing, paying special attention to the muscles that will get the most use during play (for example, a pitcher should focus on warming up the shoulder and arm).
• Teach your child not to play through pain. If your child gets injured, see your doctor. Follow all of the doctor’s orders for recovery and get the doctor’s permission before your child returns to play.
• Make sure first aid is available at all games and practices.
• Talk to and watch your child’s coach. Coaches should enforce all of the rules of the game, encourage safe play and understand the special injury risks that young players face.
• If you are not sure if it is safe for your child to perform a certain technique or move (such as heading a soccer ball or diving off the highest platform), ask your pediatrician and the coach about it.
• Above all, keep sports fun. Putting too much focus on winning can make your child push too hard and risk injury.

Whether your child plays sports or enjoys other types of activities, it is important to ensure that he or she practices healthy habits. The AHA recommends the following tips for raising a heart-healthy child:

• Help your child develop good physical activity habits at an early age by setting a good example yourself and practicing heart-healthy habits.
• Limit television, movies, videos and computer games to less than two hours a day. Substitute the rest of leisure time with physical activity.
• Plan family outings and vacations that involve vigorous activities, such as hiking, bicycling, skiing, swimming, etc.
• Give your child some household chores that require physical exertion, keeping in mind his or her level of strength, coordination and maturity. Mowing lawns, raking leaves, scrubbing floors and taking out the garbage not only teach responsibility but also can be good exercise.
• Observe sports and activities your child likes, then find out about lessons and clubs. Some children thrive on team sports. Others prefer individual activities. Some activities, like tennis and swimming, can be enjoyed for a lifetime and are much easier to learn during childhood.
• Stay involved in your child’s physical education classes at school. Ask about frequency of classes and activity, class size, curriculum (instruction in lifetime fitness activities as well as team sports should be emphasized), physical fitness assessments and qualifications of the teacher (should hold appropriate certification in physical education and be an appropriate role model for students). Physical fitness should be measured at the beginning and end of each year, and goals should be established for each child. Encourage your school board to emphasize skills students can use for the rest of their lives.
• Discourage homework immediately after school to let your child find some diversion from the structure of the school day. Kids should be active after school and before dinner.

American Academy of Family Physicians

American College of Sports Medicine
American Heart Association
National Center for Catastrophic Sports Injury Research
SafeUSA