In Spain, many children and adolescents are involved in sports activities. In fact, the “Physical Activity” working group of the Spanish Association of Pediatrics recommends moderate physical activity for at least 60 minutes a day three days a week.
Since June 2013, a law was established to protect the health of the athlete and fight against doping in sports activity. Thus, the highest body of sport in our country, the Spanish Agency for Health Protection in Sport, will determine, progressively, the obligation to perform medical check-ups before obtaining the federative license for those sports in which it is considered. This measure will not affect the practice of non-federated sports, which is carried out by a large number of children and adolescents.
Sudden cardiac death
Specialists in pediatric cardiology consider sudden cardiac death to be that which occurs during physical exercise or in the hour following its completion. In addition, it should be noted that most cardiovascular events occur during recreational sports. In any case, cardiovascular events linked to sports activity are fortunately very infrequent in the pediatric age group and are related to cardiomyopathies and congenital anomalies of the coronary arteries, channelopathies and pre-excitation syndromes, valvulopathies, aortic dissection, myocarditis and commotio cordis.
Thus, it seems reasonable to establish a protocol for pre-sport monitoring to detect potentially lethal cardiovascular diseases. In this regard, in February 2015 the Spanish Society of Pediatric Cardiology and Congenital Heart Disease (SECPyCC), the Spanish National Sports Council and the Spanish Agency for Health Protection in Sport have developed a “Clinical Guide for Cardiovascular Assessment prior to sports practice in pediatrics”.
Preventive cardiovascular assessment
As a preventive measure, specialists in Pediatric Cardiology recommend a cardiovascular assessment prior to practicing sports in children and adolescents. This assessment includes a complete medical history, including a history of heart murmur, arterial hypertension, prolonged medication intake in the last two years, unclarified seizures or other diseases that the child or his family perceive as a potential danger. In addition, a family history of cardiac problems, cardiomyopathies, arrhythmias or sudden death before the age of 50 years is asked.
Other data to be taken into account are the child’s symptoms: if the child has complained of chest pain on exertion, the presence of syncope or presyncope or the sensation of a very fast heart, palpitations or irregular heartbeats. We will also ask if the patient usually gets fatigued before the rest of his peers when practicing sports.
The next step is to perform a complete physical examination including anthropometry with weight, height and body mass index, blood pressure, cardiopulmonary auscultation and palpation of peripheral pulses. Special attention should be paid to the presence of thoracic deformities such as pectus excavatum or pectus carinatum and to the search for stigmata of Marfan syndrome.
We will always perform a 12-lead electrocardiogram, which allows a systematic reading of it. In this reading we will be able to notice small frequent alterations in the pediatric age that do not require any limitation for the practice of sports, but also more severe alterations, whose evaluation may require the performance of complementary explorations.
Advances in preventive control
In order to carry out a more rigorous examination, Dr. Centeno Malfaz incorporates a 2D color Doppler echocardiography. This test allows an assessment of the cardiac anatomy, as well as the way in which the heart is functioning. In this way we perform a deep cardiovascular observation, leaving the application of other tests such as ergometry, holter-ECG or cardioresonance for selected patients who present alterations in this first evaluation.
Finally, remember that we recommend repeating the evaluation every two years as long as the results suggest the absence of cardiovascular pathology. Otherwise, more frequent revisions may be necessary.