New screening guide for congenital heart disease

A 14-point checklist, not an electrocardiogram (ECG), should be the first step in screening young people aged 12 to 25 years for congenital and genetic heart conditions that can lead to rare sudden death, according to a new joint scientific statement from the American Heart Association (AHA) and American College of Cardiology (ACC).

News: Sodium intake on the rise in kids

The checklist, which includes components of personal and family medical history and physical examination, is recommended for screening nonathletes as well as competitive athletes, the focus of recent concern about sudden cardiac deaths. In fact, no evidence suggests that athletes are more likely to suffer sudden cardiac arrest than young persons who don’t play sports, the statement notes.

Positive findings on the history or physical exam may necessitate further testing, but using a 12-lead ECG as the initial screen for underlying problems in the 12- to 25-year age group hasn’t been found to save lives, according to the AHA and ACC. Moreover, changes in the heart in growing teenagers can make it difficult to discern whether an ECG is abnormal, and false negative and positive results can lead to missed diagnoses or unneeded testing. Mass ECG screening of athletes, as some countries have called for, would be very expensive, the statement points out.

The 14-point screening checklist recommends assessing for a history of chest pain or excessive shortness of breath or fatigue on exertion; unexplained fainting; high blood pressure; previous restriction from sports participation; previous heart testing ordered by a physician; and cardiac-related death or disability before 50 years of age in a close family member or members. The physical exam should include femoral pulses, brachial artery blood pressure in a sitting position, and evaluation for heart murmur and signs of Marfan syndrome.

When cardiac arrest does occur, wider availability of automated external defibrillators in places such as schools and athletic stadiums could prove “highly effective” in saving lives, the joint statement observes.

To get weekly clinical advice for today's pediatrician, subscribe to the Contemporary Pediatrics PediaMedia.