Sports Screening Clinic

At Alexander House we offer 2 screening packages

Young Person Screening - screening for those aged 12 years and above

The appointment will include an ECG, physical examination and consultation. A written report will be provided within 7 days.

This is recommended for young people involved at any level of sport or with family history of heart problems.

Comprehensive Sports Screening for athletes

The appointment will include history taking, physical examination, blood tests to include blood sugar and cholesterol, resting ECG and Echocardiogram. Where appropriate an exercise ECG may also be undertaken. A full report will be provided within 7 days.

Why do we have Cardiac Screening?

We use cardiac screening to looks for abnormalities in the heart. When detected, we are then better able to plan treatments to help prevent cardiac problems in the future.

There is general consensus around the world that cardiac screening should be carried out on athletes. It is also estimated that 12 young people under the age of 35 die from sudden cardiac death every week in the UK.

The European Cardiac Society recommends cardiac screening in those over 12 participating in any form of competitive sports (www.sportscardiology.co.uk)
Screening has not been adopted in the UK, but the charity CRY is campaigning for cardiac screening with an ECG for all 14 year olds.

In Italy, since 1982, all young people under age of 35 who participate in sporting activities have been required by law to undergo annual health screening. This has led to a dramatic 89% reduction in sudden cardiac deaths, particularly in hypertrophic cardiomyopathy (HCM), an inherited condition that leads to thickening of the heart muscle and can be associated with dangerous changes in the heart rhythm.

Professional bodies such as FIFA and the International Olympic Committee recommend cardiac screening for all their sportsmen and women. The American Heart Association and European Society of Cardiology have prepared guidelines to facilitate this.

More detail

Regular exercise increases both quality of life and life expectancy. In general, exercise reduces the risk of premature mortality and in particular, the risk of developing coronary heart disease, hypertension, colon cancer, obesity and diabetes. Public awareness of the health benefits of exercise is rising and increasing numbers of individuals are returning to regular exercise after years of relative inactivity. The popularity of mass participation sporting events such as the London marathon and the Great North run and the growing number of people now participating in endurance sports such as triathlons, means that many older individuals are now undertaking intensive training, perhaps for the first time in their lives. However, there is a perception that, without proper screening, some of these athletes may be at increased risk of physical injury or even death.

The sudden, unexpected and tragic death of a young athlete often results in extensive media attention. Such deaths are usually due to underlying, undiagnosed congenital or acquired cardiac disease. Whilst rare, with an annual incidence estimated at between 1 in 20,000 and 1 in 300,000, sudden cardiac death (SCD) nevertheless remains the leading cause of non-traumatic death in athletes below the age of 35. Intense athletic activity can trigger SCD or disease progression in these individuals. In a 2003 study, Corrado showed that individuals who regularly participate in training and athletic competition have an average 2.8 times increased risk of SCD compared to their non-athletic peers.

There is now international consensus on the need to pre-screen competitive athletes to improve the detection of cardiac abnormalities, many of which are asymptomatic, to help minimize the risks associated with athletic participation. The American Heart and the American Stroke Associations and separately, the International Olympic Committee, have published recommendations for pre-screening of all young athletes, from non-competitive teenagers to young adult professional athletes. As a nation, Italy has led the way, introducing, in 1982, a nationwide cardiovascular screening programme for all people participating in sport at any level between the ages of 16 and 35. Young athletes in Italy are now less likely to be victims of SCD than their non-athletic compatriots. In the UK professional athletes in sports such as football, rugby, cricket and tennis undergo rigorous annual cardiovascular assessments.

For older athletes, no such consensus exists, even though it is recognised that cardiac events in older athletes are more common and are more likely to be due to undiagnosed coronary artery disease. It is recommended that triathaletes have medical approval to compete, in the form of a letter from a GP stating that there are no medical concerns, but even at international level this is not mandated and no pre-competition medical screening is required.

The vast majority of athletes dying suddenly have no warning symptoms and therefore periodic health evaluation (PHE) is the only way of identifying silent cardiac disease. By identifying such disease, appropriate prophylactic measures can be taken to minimise the risk of SCD. Measures might include restricting competitive sports activities, or prophylactic treatment with drugs, implantable defibrillator devices (ICD) and other therapeutic options. Timely identification and appropriate clinical management of athletes who carry an increase cardiac risk can lead to long-term favourable outcome.

Screening of athletes using PHE has been shown to be cost effective. A study in Switzerland examined 1070 athletes aged between 14 and 35 over a 14 month period. 6.3% of those screened required further investigations. More than 50% of this group had abnormal resting electrocardiograms (ECG). Previously undiagnosed cardiac abnormalities were found in 22 athletes, 5 of whom had abnormalities associated with SCD. For older athletes the detection rates for cardiac abnormalities will be a factor higher, pointing to an even greater need to screen such individuals.

It is worth noting that as many as 25% of first degree relative of an individual suffering a cardiac arrest will themselves have abnormal ECGs. On a more positive note, data from the Dutch Amsterdam Resuscitation Study has shown that individuals suffering a cardiac arrest during or shortly after exercise are three times more likely to survive that those whose arrest was not exercise related.

The current European recommendations for pre participation screening in younger athletes up to the age of 35 years, comprise a detailed medical history, focussing particularly on any family history of unexpected premature deaths and unexplained episodes of loss of consciousness, both in the individual being screened and in family members. This is supported by physical examination, looking for any cardiac abnormalities, such as heart murmurs or rhythm disturbances (arrhythmias) and a resting 12 lead ECG. For competitive athletes this screening should take place periodically (PHE), the frequency of such evaluations being determined by the relevant sports governing bodies or professional organisations.

If no abnormalities are found then the risk of SCD is extremely low and no further investigations are required, but If screening does reveal potential problems then further, appropriate tests may be required.

For older athletes, more comprehensive screening is recommended, with the addition of an echocardiogram (an ultrasound of the heart) and an exercise, or stress ECG test. This is mainly because coronary artery disease is more likely in older individuals, even if they have no cardiac symptoms, such as chest pain of breathlessness on exertion. As a consequence of these recommendations in older athletes, screening will be more expensive and perhaps less readily accessible.