Electrocardiograms (ECGs) & the Physical Exam for Athletes

Electrocardiograms (ECG) have become a routine part of pre-participation physical exams at the collegiate level. The thought behind the use of ECGs is to screen for cardiac adaptations that may lead to sudden cardiac death. Is this practice something that should be implemented for high-school aged athletes as well? Specific considerations should be addressed in the discussion of this topic. For example, who will pay for the follow-up tests, will physicians be given guidelines on abnormal ECG findings, what type of physician should be reading the ECGs, how can false-positive tests be minimized, and will everyone be given an ECG or just those considered to be at high risk?

Budgets at the high-school level are rarely comparable to those at the NCAA Division 1 level, so most likely, the student-athletes would be responsible for the costs associated with the ECG. According to the 2009 Medicare Physician Fee Schedule, the average cost of an ECG is $371. According to research, data predicts that 16% of ECG readings would be read as positive for a cardiac abnormality; however, only 1.3% of that 16% would actually have the abnormality. This leaves a large majority of student-athletes spending money on follow-up costs.

Cardiac abnormalities are often classified as training-induced or pathological which points to the need for physicians to be up-to-date on reading ECGs. Specifically, physicians and exercise physiologist should work together to create ECG guidelines on what is training-induced versus abnormal readings. Also, it could be beneficial to require physicians that are specifically trained in cardiac abnormalities to read the athletes’ ECGs. For example, a cardiologist would be much better practiced at reading ECGs than an orthopedic doctor.

Since research has shown that black males are at the highest risk for cardiac abnormalities, perhaps the ECG screening could be limited to this population. In addition to black males, anyone who has a history indicative of a cardiac abnormality, as defined by the American Heart Association, should also be required to have an ECG prior to participation in athletics.

Athletic trainers need to be educated about the importance of a thorough PPE in order to protect our athletes and do everything in our power to prevent sudden cardiac death. Athletic trainers are in the unique position where we can implement screening tools at the school and also encourage our team physicians to be current on abnormal ECG guidelines.