The Tennessee State Department of Education has mandated that all rising 7th and 9th grade athletes will have to take a more thorough physical in order to compete in school athletics this coming fall. This is in addition to the TSSAA physical. The comprehensive exam will include a thorough health history, behavior and mental health assessment, a physical exam, screening for hearing and individual specific lab tests, immunizations, and age-appropriate education for anticipatory guidance. It's the last category that raised questions for me. I hope that education about the dangers of anabolic androgenic steroid abuse is included. But it's what that's not specifically included in this exam that concerns me. A student athlete should get a standard 12-lead electrocardiogram (EKG). A small number of student athletes collapse during strenuous exercise each year from sudden cardiac arrest. Invariably at autopsy, the cause of death will be found to be idiopathic hypertrophic cardiomyopathy. This is a medical term that means the athlete had an enlarged heart with deviation from the normal in the heart muscle that resulted in a sudden disruption of the electrical current conduction that controls normal beating of the heart.

To be quite upfront, only an advanced specific version of an EKG known as an echocardiogram will specifically identify the condition of hypertrophic cardiomyopathy, the primary 12-lead EKG should identify that small percentage of athletes who exhibit conduction abnormalities and should then be referred to a cardiologist for possible secondary screening via an echocardiogram. An echocardiogram is rather expensive, but the primary baseline EKG is reasonable.

Such preventive steps might save a life. An athlete who is diagnosed with idiopathic hypertrophic cardiomyopathy should compete in athletics only after being cleared by a cardiologist, and that athlete should remain under the care of that cariologist throughout his/her athletic career. An automated external defibrillator (AED) and someone trained in CPR and AED use should be readily available at all school athletic contests. Students in grades 10 - 12 will have only to get the traditional TSSAA physical exam. The 7th and 9th grade students will also have to get the TSSAA standard physical exam. An MD, DO, PA, or NP must only do the standard TSSAA physical exam.

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Steve Moore
Cookeville, TN