SPORTS SCREENING PROGRAM

Vision Cardio DiagnostixÒ is a company that was formed to provide affordable cardiovascular diagnostics to many needy Kenyans enabling patients to get timely therapy and chance for better outcomes. This is because heart disease continues to plaque many Kenyans and most people get a late diagnosis due to unavailability of diagnostic tests or indeed inability to afford the test.

Amongst the services offered include cardiovascular diagnostic tests such as electrocardiogram (ECG), echocardiogram, exercise ECG, prolonged heart rhythm monitoring (holter) and ambulatory blood pressure testing.

The company is working directly with the patients and their insurance companies to enhance provision of these services.

One of the unique services we offer is the competitive athletes screening program

 

What is athletes screening?

Sportsmen remain a segment of the society that is relatively healthy and are called upon to deliver under immense physical and mental stress. Occasionally, athletes suffer cardiac arrest during the course of their duty and some of these may be fatal. These cases tend to carry a lot of media and public attention partly due to the dramatic nature of the events but also due to the youth of the sportsmen. Many questions are asked as to whether these events could be prevented.

The American Heart Association (AHA) and the American College of Sports Medicine (ACSM) have issued multiple guidelines to enable physicians and sportsmen understand the level of screening necessary before competitive sports. The AHA issued the last guidelines in 2007 and the European Society of Cardiology (ESC) and the international Olympic Committee (IOC) also issued similar guidelines.

Key amongst these guidelines is the variability in the recommendations. These tend to vary in different societies and the level of competitiveness of the sportsmen. It is emphasized that the guidelines should not scuttle the requirement for sports activity but most importantly identify individuals who are at risk for sudden cardiac death and determine mitigation measures or indeed exemption from sporting activity.

Notable amongst the guidelines is also the requirement for each country to facilitate the appropriate screening of athletes with the view to minimize adverse events during sporting activity and being cognizant of the cost implications of such initiatives.

How common is cardiac arrest in sports?

Generally, sudden cardiac death in athletes is infrequent. The incidence varies from 1:3,000 athletes to 1 in a million, the wide variability being explained by the wide population range of the athlete population. An analysis performed by the National Collegiate Athletic Association (NCAA) in the USA found highest risk to be associated with male gender, black race, and basketball participation. The risk among male division 1 basketball players has been estimated at more than 10 times that in the overall athlete population (1 in 5,200 vs. 1 in 53,703 athletes per year). After basketball the next highest risk is in men’s soccer and men’s football. The risk also tend to increase with age, particularly after the age of 35 years.

 

What are the common heart conditions that cause sudden cardiac death in athletes?

In a large registry from the Minneapolis Heart Institute Foundation Registry from 1980 to 2005 involving 1435 young competitive athletes sudden death the commonest cause of sudden cardiac death was hypertrophic cardiomyopathy accounting for 36% of the cases. The second most common cause is anomalous coronary arteries accounting for 17%. Indeed, throughout the world hypertrophic cardiomyopathy constitutes the commonest cause of sudden cardiac death. Unfortunately, most of these patients do not have a family history and they do not have any previous warning signs.

In Europe, and mostly in the Mediterranean belt the, an important cause of sudden death in athletes is arrythmogenic right ventricular dysplasia (ARVC). This is a genetic disease that can be screened and diagnosed early and commonly rules out the athlete from competitive sport. Italy and Europe instituted mandatory screening for all competitive athletes from the 1970s and deaths from this condition have significantly dropped. Indeed, no Italian athlete has died from this condition in last decade or so.

What is the standard protocol?

As mentioned above the screening varies in different societies and the level of competitiveness. For example, societies such as the national basketball association have some of the stringiest pre-participations rules largely due to the intensity of the sport and the diverse sportsmen the sport tends to employ.

The standard protocol includes use of sports physicians and cardiovascular professionals with skills in administration and interpretation of the information required for screening of the athletes.

At Vision Cardio Diagnostix we follow the AHA recommendation for level I athletes screening. This covers a wide variety of athletes in colleges or high school.

Level II athletes includes the highest level of competition mostly a national leagues and athletes likely to play at international level.

A third level include part time athletes mostly adults. This level of assessment is different as the risk is individualized.

Level I Testing

This is a two stages assessment that includes: –

1. Filling of a questionnaire that assess the patient risk through history and physical examination
2. Electrocardiography (ECG)

If any of the stages is abnormal then an echocardiogram and further tests may be warranted. Abnormal tests are referred for therapy as appropriate.

Level II Testing

This is a 3 stages assessment that includes: –

1. Filling of a questionnaire that assess the patient risk through history and physical examination
2. Electrocardiography (ECG)
3. Echocardiography

For an athlete to participate in competitive sports they must pass the three assessments and a comprehensive report provided.

Athletes who are found to have abnormal tests are referred for further assessment and therapy as appropriate. Where remedial action is possible some of these athletes may be allowed to competitive sports.

Level III testing

This is preferred for adults who want to participate in competitive sports individually or as teams.

This is a 4 step process that includes: –

1. Filling of a questionnaire that assess the patient risk through history and physical examination
2. Electrocardiography (ECG)
3. Exercise ECG
4. Echocardiography

Capacity

Vision Cardio Diagnostix is equipped with the latest and up-to-date equipment to enable the provision of the above services.

We have the best technical staff and physicians and cardiologists at hand to deal with all the patients and athletes that we encounter.