Last week the annual conference of the American Medical Society for Sports Medicine (AMSSM) was held in San Diego. This is the largest Primary Care Sports Medicine conference in the United States, with over 1,400 attendees.
The AMSSM attracts the leading experts from around the world to present on the latest research and recommendations on a variety of topics. Two of the highlighted topics this year were screening for sudden cardiac death and concussions.
Numerous cardiac abnormalities can cause a potentially fatal issue for athletes. The difficulty is in identifying these abnormalities before the event happens. Many of these conditions show no signs or symptoms for the patient. Recently a conference was held in Seattle looking at how some of these ailments may be identified by performing an EKG on the athlete during their pre-participation physical exam.
The findings of the Seattle conference were presented at the AMSSM. A series of online training modules was developed to help educate sports medicine physicians in interpreting EKGs in athletes. These modules will be available free of charge.
Controversy exists over whether the EKG is the best tool for identifying athletes at risk and if performing EKGs (and other tests that would be needed for any positive findings) is cost-effective. Echocardiography (ultrasound evaluation of the heart) gives more direct information about the structure and function of the heart, and cardiac MRI is an even more advanced evaluation tool. However, the cost of both of these modalities makes it prohibitive from using them for screening purposes.
While the EKGs will not identify all athletes at risk for sudden cardiac death, there is potential for increasing the number of heart abnormalities we can identify before an athlete steps onto the field.
Also at the AMSSM conference, the updated concussion recommendations were discussed. One of the important points to remember is that the athlete can have a myriad of symptoms from a simple headache to memory impairment, emotional liability, and balance problems to loss of consciousness. Any athlete with symptoms that are suspicious for a concussion must be evaluated by a physician who has been well-trained in the diagnosis and management of concussions.
As the athlete’s symptoms improve they will be returned to play gradually, going through specific steps which increase the intensity of exercise. Any symptoms that recur during this process show that the brain has not healed well enough to return to full activity. The physician will alter the plan accordingly.
Another important factor to consider is that younger athletes typically take longer to recover and fully heal from concussions. It may be difficult for the concussed student-athlete to concentrate effectively and perform schoolwork, so they may be held out of school for a period of time to let their brain heal. Return to learning also follows a step-wise progression.
We still have much to learn about what really is happening in the brain when someone is concussed and what the long-term risks and effects are and why. But what we do know is that concussions must be taken seriously and treated properly to try to limit these issues.
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