Sudden Cardiac Death in Student Athletes – PediaCast 535
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Show Notes
Description
- Dr Tom Pommering and Todd Peterson visit the studio as we consider sudden cardiac death in student athletes. These events are rare, but devastating… and the difference between life and death depends on the quick actions of those nearby. We hope you can join us!
Topic
- Sudden Cardiac Death in Student Athletes
Guests
Links
- Sports Medicine at Nationwide Children’s Hospital
- American Red Cross (CPR Training)
- American Heart Association (CPR & First Aid)
- AED’s – PediaCast 251
- Sports Physicals – PediaCast 424
- Refining the Sports Physicals – PediaCast CME 005
Transcription
Announcer 1: This is PediaCast.
[Music]
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We are in Columbus, Ohio.
It's episode 535 for April 11th, 2023. We're calling this one "Sudden Cardiac Death in Student Athletes". I want to welcome all of you to the program.
So we have another important topic for you this week, as we consider sudden cardiac death in student athletes, which, by the way, does not have to lead to actual death if the right equipment and the right people with the right skills happen to be nearby. Which is what makes this topic so important, because you might be that right person who is nearby when an athlete goes down on the playing field or the practice court.
0:01:23
We all saw this happen a few months ago in the NFL. Damar Hamlin was playing safety for the Buffalo Bills during a game against the Cincinnati Bengals when he collapsed following a tackle. Now, we do not know with certainty the reason for his collapse because we don't have access to his medical records. But a likely scenario is that he was hit hard in the chest, which caused his heart to change its electrical pattern.
So instead of all the muscle cells contracting in unison, they became unsynchronized, which is called myocardial fibrillation. And that means that the heart is no longer functioning as a single pump, since all those muscle fibers are out of sync and just sort of contracting willy-nilly.
0:02:09
So the blood then does not move forward in an effective manner. And this ends up robbing tissues, including the brain and the heart, of oxygen, which results in loss of consciousness and a heart attack. And death can quickly follow if the heart is not converted back into a synchronized rhythm that can resume pumping blood forward throughout the body.
Now, thankfully, this is a rare occurrence when a seemingly healthy young athlete collapses during play because of a heart issue. But it does occur in a middle school, high school, college, and professional sports from time to time.
In fact, before Damar Hamlin, you likely have heard a story about this sort of thing happening in your community. And when it does occur, the survival rate can hover around 50%, which is not great. But the thing that makes the difference is the quick action of people in the vicinity.
0:03:07
And actually, that survival rate is much improved over previous time periods due to the availability of trained people and AEDs, which we will talk about in more detail during the course of this program.
And that skilled person, again, could be me or you someday. So it is important to have an idea of what we need to do to save an athlete's life who suddenly goes down.
And so that's what we're going to explore today sudden cardiac death in student athletes. We'll take a closer look at the cause of these events and identify some risk factors. We'll talk more about CPR and AEDs. And we'll discuss long-term consequences and the ability to continue playing sports after something like this happens. And we'll consider screening tests, especially on high-risk individuals.
All of this is coming your way soon, of course, in our usual PediaCast fashion. To help us with the conversation, we have two terrific studio guests joining us. Dr Tom Pommering is Chief of Sports Medicine at Nationwide Children's Hospital. And Todd Peterson is a certified athletic trainer, also with Sports Medicine at Nationwide Children's.
0:04:10
Before we get to them, let's cover our usual quick reminders. Don't forget, you can find us wherever podcasts are found. We're in the Apple and Google podcast apps. iHeartRadio, Spotify, SoundCloud, Amazon Music and most other Podcast apps for iOS and Android. If you like what you hear, please remember to subscribe to our show so you don't miss an episode.
Also, please consider leaving a review wherever you get your podcasts so that others who come along looking for evidence-based child health and parenting information will know what to expect.
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Also, don't forget, we have a contact link at pediacast.org, if you would like to suggest a future topic for the program.
Also, I want to remind you, the information presented in our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider.
0:05:05
Also, your use of this audio program is subject to the PediaCast Terms of Use agreement, which you can find at pediacast.org. So let's take a quick break.
We'll get Dr. Tom Pommering and Todd Peterson settled into the studio. And then, we will be back, to talk more about sudden cardiac death in student athletes. It's coming up right after this.
[Music]
Dr. Mike Patrick: Dr. Tom Pommering is Chief of Sports Medicine at Nationwide Children's Hospital and a Professor of Pediatrics at the Ohio State University College of Medicine. Todd Peterson is a certified athletic trainer at Nationwide Children's. Both are passionate about helping athletes parents and families impacted by many health conditions, including sudden cardiac death.
0:06:13
That's what they're here to talk about life threatening events involving the heart during sports participation. But first, let's extend a warm PediaCast welcome to our guests, Dr. Tom Pommering and Todd Peterson. Thank you so much for stopping by today.
Todd Peterson: Thank you.
Dr. Tom Pommering: Glad to be here, Mike.
Dr. Mike Patrick: I really really appreciate both of you taking time out of your busy schedules to join us. We usually start with definitions. And so, I want to do that today, because when you think of sudden cardiac death, I mean, the word death is in there. And so you think, oh, does this mean that someone dies? But not necessarily right, Todd?
Todd Peterson: Correct. It doesn't always mean that you're going to pass away from a sudden cardiac death episode. With all the measures that we have in place, CPR, all that kind of stuff, that is a helpful thing for having trained professionals around to be able to have that early intervention.
0:07:03
Dr. Mike Patrick: Yeah, absolutely. So what does that mean? What exactly is happening when there is sudden cardiac death?
Todd Peterson: Sudden cardiac death is an unexpected death from a heart episode. It's a loss of heart function. Usually, a sudden cardiac arrest causes it. And it usually occurs within one hour from the start of cardiac-related symptoms. Sudden cardiac death is the largest cause of natural death in the United States.
Dr. Mike Patrick: Yeah, absolutely. So if we think about the heart as a pump, and all those little muscles that make up the heart, in order for them to all contract at the exact same time, there's electrical impulses that have to travel through the heart kind of in a synchronized way, so that all the muscle cells contract together.
And so if that electrical pattern is disrupted and the cells just start contracting willy-nilly, they're working against each other, so you get a rhythm of the heart that's not going to pump blood forward. And then, because the blood is not pumping forward, you're not getting oxygen to the brain and you pass out. And then your heart's not getting enough oxygen either, and so bad things happen, and it can lead to death pretty quickly.
0:08:21
What are some causes of sudden cardiac death, Tom?
Dr. Tom Pommering: Yes. So you can think of this as either a structural problem with the heart. In other words, there's a problem with the anatomy, like a valve that isn't working right or the muscle is thickened in places it's not supposed to. Or an electrical phenomena where those pathways that go through the heart are disrupted and are not sending those signals in a coordinated way. So you're not pumping your heart efficiently. And sometimes it's both.
Dr. Mike Patrick: And so a lot of times, these are things that a person might be born with, but it doesn't really become an issue until they are really active and participating in sports, right?
Dr. Tom Pommering: Yeah, for sure. Definitely, intense exercise can be a trigger for this, but also just getting older and having a condition that might be inherited sort of mature and come to fruition when you get past a certain age.
0:09:12
Dr. Mike Patrick: Yeah, absolutely. Now, fortunately, this is a rare occurrence, but when it does happen, it can be devastating. And I think most people who are listening to this can remember a time in their own community when they've heard of something like this happening. So it's not one of those hypothetical things. It really does happen out in the real world.
So, Todd, how common is this condition? And who is at risk for having it happen to their family.
Todd Peterson: It's one of those you just never know when it's going to happen. I mean, there's been times where I was in clinic and I had to run down and help a bystander that wasn't even there for clinic that day perform CPR. I personally haven't had anything within my school other than some elderly people that have been there watching the games and things like that.
0:10:04
So it kind of is rare, but it still happens. It most frequently occurs in adults with a sudden cardiac of death in their mid-thirties to mid-forties. It affects men and people assigned male at birth a lot more than women and ones that have been assigned women at birth. And it's even more rare in children. I think I looked the other day and it was like more of like 1 in 2 out of 100,000 in children who it affects the most during that.
Dr. Mike Patrick: But if you think of a large city with like a million people, we're talking ten kids in a year that this could happen to. So even though it's rare, it's still something that happens from time to time. And we all really ought to be prepared for it in some way, because any of us, even if you're a spectator at an event, could potentially save a young athlete's life, right?
Todd Peterson: Yes.
0:11:07
Dr. Mike Patrick: So very important. Now, if an athlete goes down, it does not necessarily mean that their heart has stopped. There are other reasons why an athlete might collapse during sports participation. So what are some of the things, Tom, that could cause an athlete to go down other than a heart problem?
Dr. Tom Pommering: Yeah, good question, Mike. So obviously, when an athlete goes down, our first concern is, has your heart stopped? So when we approach an athlete in that situation, we're automatically preparing ourselves for the worst-case scenario. So luckily, that's not always what causes the athlete to go down. There are other things, such as something called exercise-associated collapse.
For example, end of a marathon, you'll see runners coming across and just this collapsing, which is probably caused from loss of blood flow to the brain after you stop running. And blood pulls in your legs and you don't have enough blood in your brain and you fall down, pass out.
0:12:06
There's less common things. I always worry when people attribute collapse to things like dehydration or low blood sugar, because those are not as common as you would think. You have to be really low in your blood sugar and really dehydrate for that to happen.
So I think it really behooves us, if you do have a collapse situation, even if your heart didn't stop, that may be a warning sign that you need a cardiac workup.
Dr. Mike Patrick: Yeah, absolutely. Because it could be that there was a rhythm problem that made you lose consciousness, but then it corrected itself by the time that the athletic trainers get on the field and the person starting to wake up. So was there a momentary disruption of a normal rhythm and normal pumping action of the heart? And so those kids probably do deserve to see a cardiologist and get more of a workup.
And we'll get to that here in just a few minutes. But let's say an athlete does go down. And as I'm talking about this, I'm thinking about Damar Hamlin because this just happened recently when the Buffalo Bills were playing the Cincinnati Bengals.
0:13:08
And in his case, we don't know 100% because we don't have access to his medical records, but he had been tackled and hit in the chest. And that is one of the things that can actually disrupt the heart's rhythm, is a severe impact to the chest. Sometimes, we can see that, like with a baseball that comes right back to the pitcher and hits their chest, that can disrupt the rhythm. And I would think that's an even rare occurrence, though.
Dr. Tom Pommering: Yes, definitely exceedingly rare. As you mentioned, you have to get hit in the right place at the right time in your cardiac cycle, like really milliseconds of timing. So, again, like you mentioned, we don't really know what happened to Damar Hamlin. And, unfortunately, that is not uncommon. We don't always find out what caused an athlete to collapse, but the workup is what we do to try to figure that out.
0:14:01
Dr. Mike Patrick: And really that phenomenon is why targeting is an issue in college sports and also neck injuries to the person who may be doing the targeting. But there's a lot of things that can go wrong when you hit someone's chest with your helmet, with a lot of impact and a lot of velocity and energy.
So let's say though, that an athlete goes down, the athletic trainers and coaches get to the player and there's not a pulse. So how is sudden cardiac death managed on the playing field or the practice field, Todd?
Todd Peterson: Yeah, what we do is, basically, once we get out there and they're not moving, and we know that they don't have a pulse, like if it is football, everything's coming off. Face mask, helmet, shoulder pads, everything, because we got to be able to get into being able to apply the AED. So my first thing is I'm having somebody call 911 to get the emergency squad there.
0:15:03
And then, at my school, we personally have AEDs, like all over the place. And I have one with me at all times at every sporting event. So I'm grabbing that. I'm slapping that AED on the athlete because it's going to be able to detect that heart rate and heartbeat and tell me if I need to start CPR.
And then, if it says shock advised or whatever, I'm going to go ahead and start the shock and start CPR and continue doing that until EMS arrives.
Dr. Mike Patrick: So that is assuming that an AED is readily available and not necessarily in the locker room.
Todd Peterson: Right.
Dr. Mike Patrick: If the AED is there. But maybe you can't get to it immediately, you're going to start CPR. Someone's going to start CPR right away.
Todd Peterson: Yes.
Dr. Mike Patrick: And I'll put a plug in for CPR training. I mean, I think if you're a parent with a student athlete and you're going to attend practices or games and competitions, it would behoove you to have some CPR training. And plus, it could save someone's life at the mall or at a restaurant or wherever. I feel like it's not just medical people who should know basic CPR.
0:16:17
Todd Peterson: Yeah, everybody should probably learn because you never know if it's going to be your parent that you're out with that at dinner or whatever, to be able to supply life-saving measures to that person.
Dr. Mike Patrick: Yeah, absolutely. And we're going to put in the show notes some links to the American Red Cross and the American Heart Association. They both offer CPR training and first aid training. And you can look and see what's available in your community and sign up for classes and all of that.
So just check out the show notes over at pediacast.org for Episode 535 and we'll have those links there for you.
So CPR, obviously, gets started, I love that you said call for help. Sometimes, you can forget that because you're so focused in on what do I need to do, but someone should be assigned to be calling 911 and get emergency medical services there as quickly as possible.
0:17:09
And then, you mentioned an AED. And I feel like this is something that most people these days have heard of, but may not be sure exactly what it is or how it works. So, Todd, explain what exactly is an AED and how can it save someone's life?
Todd Peterson: An AED is an automated external defibrillator. And it's used to send an electrical shock to the hearts of the person that's in sudden cardiac arrest, in order to return the quivering hearts back into normal heartbeats. So that it once can again start pumping that blood to get the oxygen and everything back through the body.
So many people think that an AED is used to restart the heart. And actually, I honestly didn't know this until the other day when I was doing a little bit of research, that it's actually the opposite. It actually stops the heart so it can get that rhythm, that electrical connection back in play and then it restarts the heart.
0:18:14
So I didn't realize that until the other day that it actually stops the heart. It's not like necessarily starting the heart again. It's stopping it to get that rhythm back into play.
Dr. Mike Patrick: So as we mentioned, when there's a pattern of electrical activity that does not result in all of the heart muscle fibers contracting in an organized and specific way, which creates that pumping action by kind of stopping everything, then where the part of the heart that starts that impulse can sort of start it again with muscle cells that aren't contracting and can get that right rhythm back again. That can definitely be life-saving, for sure.
Todd Peterson: Yeah. I mean, there was an analogy the other day that I saw, too. It's like when your computer freezes, the AED is like you turning off your computer and restarting it and rebooting your computer to get that whole thing talking back together.
0:19:13
Dr. Mike Patrick: Yeah, that makes sense. And so, these AEDs sort of assume that you really don't know what you're doing and come with an instruction card and shows you where to put the pad. You turn it on, let it analyze the rhythm, and just follow the voice commands of what it asks you to do.
Todd Peterson: Correct. Even if you've never even used one before, it walks you right through. The voice on the AED will walk you right through everything that you have to do.
Dr. Mike Patrick: A lot of schools may purchase these and just like, "Okay, we've got our AED." But there is some upkeep to that. You got to make sure the battery is okay and that you have the pads and if it ever gets used, that things are replaced.
And so I just want to put a public service announcement in there for coaching staff and school administrators. It's not just buying the AED. You also need to follow the manufacturer's instructions on upkeep. That's also very important.
0:20:05
Todd Peterson: Yes.
Dr. Mike Patrick: And keep it available.
Todd Peterson: Yes. We, at our school, I think ours are every two years that they actually get replaced and they get sent back to the manufacturer. And they get us new ones every two years, to make sure that the batteries are staying charged and all that kind of stuff.
So every year, we actually replace all the pads as well because for some reason they can go bad. Maybe the stickiness of them won't last as long. So they want to make sure you have good pads in there every single year.
Dr. Mike Patrick: Yeah, that makes sense because when you think about where the AEDs are located, oftentimes, it's in a cabinet sort of outside. The air, temperatures and humidity is not necessarily controlled. And so, you could see where the adhesive might fail. And also the battery life too, with those kind of extreme conditions that it's exposed to.
Now, you said you had AEDs everywhere at your school. That is fantastic. There are also schools across America that may not have AEDs available.
0:21:07
And so, what can parents and pediatricians, family practice doctor, healthcare providers within a certain community do to increase the likelihood of AEDs being available at sporting events in their hometown?
Todd Peterson: Yeah, it's just getting the word out and how important they are to have them. A lot of people say it's cost, cost, cost, cost. Well, most of them have come down in price. And usually, $1,200 to $1,500, is that really more than that child or that adult's life? The main cost of it all is not that big. So it's just getting that word out there, the need for them and pushing to have them at every location.
Dr. Mike Patrick: And as parents, you can go to your school if you don't have it. Well, first, it's important to inquire, "Hey, do we have AEDs?" Especially if your child is participating in athletics. But then if you don't, then you can talk to the principal. You can go to the school board. Sometimes it's the squeaky wheel, and sometimes you have to ask more than once, right?
0:22:16
Todd Peterson: It's all in who you know, sometimes. Like who's the right person to go talk to about this, to get the ball rolling, to get at least one that's there at all the sporting events?
Dr. Tom Pommering: I'd even recommend talk to your athletic boosters because a lot of times you can, with relatively low red tape, get that done funded through the athletic boosters. Or even if you're in a smaller town, go to your city council and talk to them.
Dr. Mike Patrick: I mean, the school is going to provide helmets and padding. And so, I would think an AED is just part of the safety equipment that a team should have.
Now, when you travel, do you take AEDs with you? Or are you at the mercy of the place where your team is competing if it's not your home base?
Todd Peterson: Like I said, I work in a good school district where I actually have two for the athletic department. So when I do travel with football on Friday nights, I do take mine with me. Just because I don't know where the other one is for the other school.
0:23:16
Even though I'm friends with most of the athletic trainers around town that we play against and they have it right there with them, but it still could be 50, 100 yards away, and I can grab mine quicker.
Dr. Mike Patrick: And you don't necessarily know what their upkeep strategy is.
[Laughter]
Todd Peterson: Correct.
Dr. Mike Patrick: For the machine at their place, so it does seem smart to take it with you, for sure. All right, so let's say that we have a kid that goes down. They did have a heart problem. We use the AED.
The good news is that student athletes have pretty healthy hearts at baseline. And so, if you get that AED on them, there's a pretty high likelihood that you're going to correct that rhythm, right?
Todd Peterson: Correct.
Dr. Mike Patrick: And so that's different maybe than older folks who might have a heart attack because of coronary artery disease, and who may have heart muscle that's not getting great oxygen, anyway. And that can make it more difficult for the AED to actually work for them.
0:24:13
However, young athletes, this really can be life threatening and often is. So let's say that we're obviously going to transport that kiddo to a hospital to be evaluated. And then, Tom, what kind of workup can families expect after that, when they actually go see a cardiologist?
Dr. Tom Pommering: I think one thing to remember is whether this is an acute sudden cardiac arrest event or if it's near or miss, where somebody passes out in the field and they're getting a cardiac workup. Parents need to know that this is going to take a little while to work this out.
So be patient. We know the athletes want to get back on the field, but they're going to need a pretty thorough workup to try to identify this. So things such as you're going to get some heart tracing to look at your electrical activity. You'll probably get some imaging, such as an ultrasound or an MRI.
You might get a stress test to see if we can invoke some of those abnormal rhythms. But your workup will be pretty extensive and pretty complete with the hope that we can identify the cause of this.
0:25:15
Dr. Mike Patrick: And keep in mind when you do an EKG, when you put the electrodes on and you get that tracing, that's just a snapshot in time. So if they're not having symptoms at the moment that you do that, you might not see anything. And so, there's also the monitors that you wear for a little bit of 24 to 48 hours or maybe even a little longer.
And then if you are feeling lightheaded or dizzy or have any kind of events, you can push a button and then a computer can take a look at all that data and see, hey, was something going on when the button was pushed? So that can be helpful in terms of something that's more intermittent. And like you said, a stress test where let's recreate vigorous activity and see what the heart is doing during that.
But like you said, it's not something that happens overnight. And these kids aren't going to be able to participate in sports till you figure it out.
0:26:04
Dr. Tom Pommering: Exactly. And your cardiologist will decide, based on your symptoms and your family history, where to start your workup. So it may be different from one person to the next, but it will be getting a lot of different testing to really thoroughly evaluate your heart.
Dr. Mike Patrick: Yeah, it's going to be sort of individualized then, depending on what they find as to when you could participate in sports again or if you can participate in sports again. I guess the good news is most of the time these kids end up are able to, yes?
Dr. Tom Pommering: Yeah, I would say most of the time they are. It really does depend on the condition that gets discovered, if something gets discovered.
And there are certainly some conditions where it may not be safe for you to participate in your current sport. You may be directed towards a sport that has less cardiac demand. But I think the best way to figure out what's the safest is they really have a really good cardiac evaluation at a qualified facility.
0:27:00
Dr. Mike Patrick: And the pediatric cardiologists that are specially trained for children and teenagers and young adults is probably going to be your best bet in terms of that evaluation, right?
Dr. Tom Pommering: Yeah, absolutely.
Dr. Mike Patrick: What about prevention, Todd? Is there a way that we could prevent this from happening in the first place?
Todd Peterson: I don't know if we can ever prevent it overall, but it starts with keeping the heart and blood vessels in good shape. And to live a heart-healthy lifestyle like don't smoke, achieve and maintain a healthy weight, eat a heart-healthy diet, get regular exercise. And the big one for us, as we get older, manage stress.
Those all play into whether you're going to have a potential coronary artery disease of some sort later in life. But early on, it's like, stay away from the drugs, don't smoke, things like that.
0:28:01
Dr. Tom Pommering: I think the other thing, the way to look at this is the event is a sudden cardiac arrest. So how do we prevent the worst outcome, which is sudden cardiac death? And we've already kind of touched on this, but really having a good emergency action plan, a really well-planned response to the victim that's down, including all the things we talked about, initiate CPR, initiate the 911 system, get the AED on them. This is really the most control we have over trying to affect a good outcome.
Dr. Mike Patrick: Yeah, absolutely. One of the things that, in terms of prevention, if you can identify high-risk folks but most people don't know if they're at high risk or not.
What are some things in an individual's history and in their family history that might raise a little bit of a red flag that perhaps we should do more of a workup even before something happens?
Dr. Tom Pommering: Prevention has been a challenge for this problem. It's trying to find really good effective prevention strategies. So certainly, we want to know if in your family, there has been a history of a sudden cardiac arrest or sudden cardiac death at a relatively young age. And that really would be someone under 50, but especially under 35.
0:29:12
We might ask you unusual questions like, has anyone ever had an unexpected drowning? Has anyone been diagnosed with an abnormal cardiac rhythm? And there's a bunch of those that we'll ask you about.
Is there anybody that have ever passed out, felt dizzy or lightheaded during exertion or exercise? Do you have chest pain when you exercise? Things like that.
So we look for warning signs in the athlete. And we look for potential family history that might point us towards an inherited condition that you may be developing.
Dr. Mike Patrick: So that history is really important in terms of symptoms that an athlete may have had before or during exertion. And the family history, as you mentioned, that goes a long way to identifying kids that we may want to take some special interest in, that this could be a possibility.
0:30:03
A lot of folks would think, well, if we just do an EKG, we put the electrodes on, get the heart tracing as a screening tool, that may help prevent something from happening. And so, I think sometimes that gives parents a 0sense of security that things are going to be okay, some relief, but that's not necessarily the case, right?
Dr. Tom Pommering: Yeah, absolutely. I'm glad you brought that up, Mike, because that's something that parents are being directly marketed to do all the time. And you have to understand that, as Mike mentioned earlier, that EKG tracing is just 12 seconds of your life. And there are many potentially dangerous cardiac conditions that will not be picked up on an EKG.
So I think it's one thing to get that done, but having a normal one doesn't guarantee that your heart is safe. And we really need to pay attention to the big picture.
Dr. Mike Patrick: Sometimes, and as a doctor working in the emergency department, we do a lot of EKGs. And I'm not a cardiologist. And most people who do sports pre-participation examinations are not cardiologists. They're the ones ordering the EKG.
0:31:14
And the tracing spits out an interpretation that the computer comes up with. And a lot of times, it's not normal, even though when a cardiologist ends up looking at that EKG, they'll say, "Oh yeah, no, that's normal. This is not a problem."
And so, not only is it an issue of maybe not picking up an issue because it is just that snapshot in time, but it also could overdo things and cause kids to be pulled out of participating unnecessarily. And maybe even cause anxiety and stress in a family. Like, "Oh, my gosh, there's something wrong with my kid's heart," when there may very well not be anything wrong with their heart. So again, it's something that we should probably order judiciously.
Dr. Tom Pommering: Yeah, absolutely. There's about a 10% false-positive rate when we use screening EKGs. And you're exactly right, it sends alarm bells out. The athletes are immediately disqualified from exercising. And then we go down this whole path of what will be a pretty expensive workup.
0:32:12
So it is important to just know the limitations of the EKG. Now, it does pick up some conditions. I don't want to completely discount its utility, but it's really not a great screening tool when we're looking for conditions that are kind of almost a needle in a haystack.
Dr. Mike Patrick: Yeah, absolutely. I also want to talk a little bit about COVID and we did an episode of PediaCast a couple of years ago when we were seeing some myocarditis or inflammation of the heart secondary to COVID. And so tell us a little bit about that, Tom. Are we seeing less of that now since there's less COVID out there?
Dr. Tom Pommering: Yeah, so luckily, as we've had more time to study this and do really much better research than the initial studies that came out, which in the height of COVID we were all looking for information as fast as we could. So naturally, when we have more time to apply science to these things, we can understand them better.
0:33:09
So, luckily, the risk of getting myocarditis from the COVID-19 infection is probably between 0.6 and 2 to 3%. So it's really exceedingly rare.
And even for those athletes who get this condition identified on a cardiac MRI, most of them will survive it. They will recover, and they'll do fine. Now, some of that longitudinal research is still being done, but it's not near as concerning as we were initially thinking.
And again, this was based on the terrible mortality and morbidity that we were seeing in the adult population. These really sick, hospitalized adults were having really terrible things happening to their heart, myocarditis, other types of damage. And so obviously, the concern was, will our young athletes or young patients see the same thing? So, luckily, that settled down quite a bit, and the risk is much lower than we were worried about.
0:34:03
Dr. Mike Patrick: It's always great to get some good news, and especially, as we think about the pandemic and hopefully getting it behind us and in the rear-view mirror and done with. We don't need another pandemic in our lifetime.
Dr. Tom Pommering: I agree.
Dr. Mike Patrick: Save that for our great-grandchildren. All right, well, this has been very enlightening. And it's such a scary event when it happens, but I want to really pound home the point that everybody that attends sporting events, especially if you have a student athlete, learning CPR is really an important thing, being comfortable. A lot of these classes, too, with CPR, they'll actually have an AED that you can kind of practice with and see what it looks like, even though not all AEDs are exactly alike.
I think just seeing the equipment and how it operates and how you put the pad on can be very important for parents. And so, again, please check out the show notes over at pediacast.org, and we will have links to where you can find CPR training in your local community.
0:35:04
Tom, before we go, tell us a little bit more about Sports Medicine here at Nationwide Children's. You guys have a really large, comprehensive program.
Dr. Tom Pommering: Yeah, we continue to grow, and we are all around in your neighborhood and around the city. And I would say kind of one of the most exciting things coming up for us is in about a year. We'll open a new facility downtown near the main hospital. We'll have a little over 30,000 square feet that will be dedicated to keeping athletes safe and healthy and returning them back to activities. So we're very excited about that.
Dr. Mike Patrick: Yeah, absolutely. And we'll put a link in the show notes also to Sports Medicine at Nationwide Children's, so you can discover lots more about what they do for yourself. And that, again, will be in the show notes.
So, once again, Dr. Tom Pommering, Chief of Sports Medicine at Nationwide Children's Hospital, and Todd Peterson, certified athletic trainer at Nationwide Children's. Thank you both so much for stopping by today.
Todd Peterson: Thank you for having us.
Dr. Tom Pommering: Glad to be here, Mike.
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0:36:29
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Also, thanks again to our guests this week. Dr. Tom Pommering, Chief of Sports Medicine at Nationwide Children's Hospital, and Todd Peterson, certified athletic trainer at Nationwide Children's.
Don't forget, you can find us wherever podcasts are found. We are in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music and most other Podcast apps for iOS and Android.
Our landing site is pediacast.org. You will find our entire archive of past programs there, along with show notes, our Terms of Use agreement, and that handy contact page if you would like to suggest a future topic for the show.
0:37:11
Reviews are helpful wherever you get your podcasts. We always appreciate when you share your thoughts about the show.
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Also, don't forget about PediaCast CME. That stands for Continuing Medical Education. It is similar to this program. We do turn the science up a couple of notches and offer free Continuing Medical Education Credit for those who listen. And that includes doctors, nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists.
And since Nationwide Children's is jointly accredited by all of these professional organizations, it's likely we offer the exact credits you need to fulfill your state's Continuing Medical Education requirements. Of course, you want to be sure the content of the episode matches your scope of practice.
Shows and details are available at the landing site for that program, pediacastcme.org. You can also listen wherever podcasts are found. Simply search for PediaCast CME.
0:38:08
Thanks again for stopping by and until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long everybody.
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Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.
