Area Physicians Weigh In on ECGs for Student Athletes
by PAUL CATALA
As the school year ramps up, parents are busy lining up appointments so their student athletes can get their sports physicals. Over the past decade, there’s been increased interest in the incorporation of electrocardiogram heart screenings in these physicals.
An electrocardiogram, or ECG, is a quick test that records the electrical signals in the heart. The results offer insight into irregular heartbeats — or arrhythmias — and can help diagnose heart attacks.
During an ECG, electrodes attached to the arms, legs, and chest monitor the heart’s electrical signals. A cardiologist then assesses normal resting heart function.
If the ECG results reveal abnormalities, more thorough cardiovascular testing may be needed to pinpoint the cause and determine whether further treatment is necessary.
According to an Office of Program Policy Analysis and Government Accountability (OPPAGA) Dec. 1, 2021, survey, 41 of Florida’s 67 counties neither require nor recommend ECG assessments for student athletes. Among those counties are Polk, Lake, Sumter, and Pasco. Six counties, including Hillsborough, recommend ECG assessments. Six counties — including Highlands, Orange, and Osceola — require assessments. Fourteen counties — including Hardee and Osceola — didn’t respond.
According to the survey, there are varying reasons behind the differing views on the need for ECGs. The reasons cited for requiring or recommending ECGs include increasing general awareness of cardiac issues, a student in another district had a “cardiac event,” and parents’ interests or requests. Those not requiring or recommending ECGs cite concerns about equal access for all students, the cost of implementation, current requirements, and sufficient information as leading factors.
Additionally, some districts cited the costs of administering and interpreting the assessment as well as the cost of follow-up care as deterrents.
Despite the challenges, two Polk County-based physicians, Dr. Agustin Ancaya and Dr. Kollagunta S. Chandrasekhar say overall, requiring or having the option of getting an ECG for high school student sports physicals can only help.
Ancaya, an internal medicine specialist at Lakeland Regional Health, says he thinks anyone playing in competitive sports should have an ECG in order to find congenital heart defects or diseases that could possibly lead to sudden death at any age. He says they should be required for early detection of cardiac problems such as cardiomyopathies and enlarged hearts.
“It’s a good idea. It only takes a minute, two minutes to do, it’s a relatively inexpensive procedure, and it’s accessible to do. I can’t think of any reasons why they shouldn’t be required,” says Ancaya, who is certified by the American Board Internal Medicine.
Chandrasekhar of KSC Cardiology in Winter Haven says he’s in favor of students in “high intensity” sports such as football, soccer, basketball, swimming, and running being required or recommended to get ECGs. However, he adds that ECGs shouldn’t be relied on exclusively and physicals should include family heart-health histories. He says young people, especially young athletes, can have underlying abnormalities that aren’t indicated due to “Athlete’s heart” — increased cardiac mass.
“You need qualified ECG readers to find symptoms that are underlying. Young people, especially young athletes, will have a lot of underlying abnormalities that aren’t indicated,” says Chandrasekhar, who is in his 30th year of practice.
“I think needing (ECGs) is an absolutely good idea, especially for the high school kid who’s in a competitive sport like basketball, but you want to make sure it’s read right. You don’t want results based on computer read-out only.”
Chandrasekhar adds that if an ECG machine reads something is abnormal, the athlete should have someone follow up and make sure there’s really an abnormality of the heart.
Dan Talbot, senior director of athletics with the Polk County School District, says he’s spoken with medical providers in Polk County, and based on what they said, there are only two pediatric cardiologists in the county, which could cause accessibility problems.
“So that poses a lot of issues for requiring it,” he says. “There have been instances where ECGs saved [young student athletes]. But there’s also the fact that every district needs equal and equitable access to proper health care.”
Talbot also says there isn’t a complete consensus in Polk County’s medical community about mandating student athlete ECGs.
“The medical providers in Polk County are split on it. I’ve talked to some that say we should require it, some say no,” he says. “It’s kind of one of those things where we kind of sit back and if it becomes state law, obviously, we’ll have to figure that out.”
Dr. Sergio Seoane, president of the Polk County Medical Association, says most experts in the field don’t perform or recommend ECG screening for competitive athletes younger than 35.
“If there is evidence, suspicion, or the presence of specific diseases (e.g. arrhythmogenic cardiomyopathy, catecholaminergic polymorphic ventricular tachycardia) then most experts would obtain an ECG,” he explains.
Kyle Kennedy, Polk County Public Schools senior coordinator for media relations, states: “At this time, ECGs are not required for student-athlete physicals by the State of Florida or Polk County Public Schools.”