Sports Injury Forum - Michael DeFranco MD, Guest - Michael LaCorte MD Pediatric Cardiology, Director of Steven and Alexandra Cohen Children's Medical Center -Brooklyn Division.
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Sudden Cardiac Death and Family History Interviewer: We’ve touched on a couple of the important things in our previous evaluation that you might look for in terms of risk of heart disease in athletes. You had mentioned before personal history of syncope, family history of sudden cardiac death, some of the things we waited, the Marfan syndrome. Are there other critical elements of the precedent evaluation that you do to really look at in athlete and say, “Does this guy have a risk for heart disease that could interfere with them?” Interviewee: The roles that we have are very different and depending on where you live, primary care doctors handle this in different ways. Typically, what a primary care physician should be doing, whether it’s a family practitioner or a pediatrician, first, we’ll getting a clear cut family history. Has anyone young -- and we’re talking about 40 or younger died suddenly? Is there a history of muscle disease of the heart in the family? The other thing you obviously find out about family history which may be relevant is anybody with a pacemaker. Has anybody had a history, a first-degree relative, a parent or a sibling that has episodes with their passing out with exertion? It may be treated with medication, may need a pacemaker or has a pacemaker. Then when you talk with the individual, what you're looking for is exercise-induced syncope. Certainly, exercises induce chest pain although, as I mentioned before, it’s not the hallmark of a lot of these diseases. You should certainly ask about it. Children that have frequent palpitations may raise something in terms of an arrhythmia. So, you get relatively concise but a critical history of what you're looking for. And then, obviously you do a physical exam. You're looking for stigmata of Marfan syndrome. You're looking at high blood pressure. You're looking for murmurs. The problem is what happens when you stop there. You’ve done your history. You’ve done your physical. Is that enough to say to someone who wants to play football, “Go ahead and play football”? That’s the controversy and it is controversial about whether or not that’s all you need. And you can obviously ask him the next question, “What do I think about it?” But, it is controversial. It’s not that obvious.
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