Follow the signs to see if your young athlete needs a cardiac evaluation, Children's doctors say

August 24, 2011

As autumn approaches and schools open their doors, parents of athletes should be watchful for signs indicating whether their children need in-depth heart evaluations before playing sports, said cardiologists and sports medicine physicians at Children’s Medical Center (

While sudden cardiac death among youths is extremely rare – and clinical detection of abnormalities may be difficult in some cases – parents can help avoid tragic events by watching for symptoms in their children such as fainting, chest pains or an abnormally racing heart brought on by exercise; shortness of breath; excessive fatigue; and/or a dramatic change in stamina.

Such deaths “are very rare events,” said Dr. William Scott, a co-director of the Children’s Medical Center Heart Center, head of cardiology and director of cardiac electrophysiology. “Statistics indicate they occur once for every 200,000 children participating in sports every year. When these do occur, very often some of the warning signs were present before.”

Basic cardiac and pre-participation evaluations for athletes won’t catch every symptom or warning sign. The best weapon against sudden cardiac death is a thorough investigation of the medical history and an examination by the child’s primary care doctor – preferably one who has seen the child for years and will be alert to any changes. Parents also can help by continuously gathering family history, which may indicate whether further tests or referrals are necessary.

The Sports Medicine Center at Children’s works closely with the hospital’s Heart Center to provide the best care possible for young athletes and to perform necessary or requested evaluations.

The mother of one Prosper High School football player knows the critical importance of these steps, and credits doctors at Children’s Medical Center with saving her son’s life by diagnosing him with a life-threatening heart condition after he experienced chest pains while exercising.

“The doctors knew even though he was just a teen in great shape, it didn’t mean he was okay,” said Georgia Colon, whose 15-year-old son Nathan Colon will no longer play football as a result of his medical condition, an abnormal coronary artery that can be corrected with surgery. “They referred us to do further tests. Further tests from cardiologists saved his life. Just because you’re 15 or 12 doesn’t mean this couldn’t happen to you.

“We went to Children’s because he’s 15, and I didn’t want a cardiologist who didn’t specialize in pediatric care to see him,” Georgia Colon said of her son. “I wouldn’t have wanted him to go to a regular emergency room where they would see what great shape he was in and say he probably pulled a muscle.”

If a child has ever fainted during exercise – or suffered chest pains, extreme shortness of breath or palpitations during workouts – doctors say it might be prudent to refer the child for an exam and comprehensive evaluation by a pediatric cardiologist. This cautionary move might also be advisable for a child beginning to experience excessive fatigue with routine exercise or showing a dramatic change in stamina.

“When there are worrisome signs and symptoms, I think they’re absolutely imperative,” Scott said of the evaluations and tests.

“Where concern has been raised about the possibility of a cardiac condition, it’s absolutely vital they go somewhere with sufficient experience to discern whether there is a risk,” said Scott, also a professor of pediatrics and cardiology at UT Southwestern Medical Center.

Physicians have access to a special phone number to reach a Children’s cardiologist 24 hours a day, seven days a week, to discuss patients’ cases and evaluations.

Dr. Shane Miller, a pediatric sports medicine physician with Children’s Medical Center, said it is also “extremely important” that an automated external defibrillator, which can restart someone’s heart, is easily accessible or within close reach when student athletes are exercising at practice or at a game.

This means the device “should be with the team, whether they’re on the field or courtside or in the training facility,” Miller said Tuesday. Having the device within close reach “could mean the difference between life and death,” he said. 

Exams and comprehensive evaluations also are advisable for any athlete whose family has a history of a sudden, unexplained death of any relative under 35 years old or a history of cardiomyopathy, Long QT syndrome or other life-threatening arrhythmias.

Other signs to look for are a family history of sudden cardiac death, an enlarged or thickened heart in young family members, the new onset of a heart murmur in a teenager or excessive anxiety or stress experienced by a child or parent, said Miller, who is also an assistant professor of orthopaedics and pediatrics at UT Southwestern Medical Center.

The most common causes of sudden cardiac deaths are hypertrophic cardiomyopathy (HCM), coronary artery abnormalities, Long QT syndrome, acute heart infections, asthma and even some non-cardiac diseases.

Electrocardiogram (ECG) screenings can identify important diseases on a regular basis. Children who don’t participate in athletics, but experience any of the troubling symptoms listed above, also may be evaluated because up to 70 percent of children who suffer sudden cardiac death do not die on athletic fields.

However, a full cardiology evaluation isn’t necessary unless a routine physical exam of the child turns up any abnormalities or there is a family history that warrants concern.

Children’s Medical Center can provide an appropriate evaluation for any child whose parents are concerned, even if evidence of a problem does not exist. Comprehensive tests and evaluations can be performed at our multiple sites throughout north Texas, including Dallas, Plano, Southlake, Tyler and Abilene.

Patients and families can schedule appointments or consultations by calling the Heart Center at 214-456-2333. Same-day and next-day appointments are available at many of our sites.