.: ORİJİNAL ARAŞTIRMA
The Preparticipation Sports Examination of Healthy Children: When Should be Referred to Pediatric Cardiologist?
Sağlıklı Çocukların Spor Katılımı Öncesi Değerlendirilmesi: Ne Zaman Pediatrik Kardiyoloğa Yönlendirilmeli?
Turkiye Klinikleri J Pediatr. 2020;29(1):14-9
doi: 10.5336/pediatr.2019-72710
Makale Dili: EN
Tam Metin
Ücretsiz Erişim
ABSTRACT
Objective: Sudden cardiac death (SCD) that may occur during sports activation of young healthy athletes is a painful condition and impose responsibilities on both families and physicians. Although, there is not an established standard protocol in medical screening of sports preparticipation, any of the screening procedure cannot completely rule out the presence of cardiovascular disease and prevent from SCD. The aim of this study is to evaluate the frequency of cardiac anomalies in healthy children evaluated by electrocardiography (ECG) and transthoracic echocardiography before sports participation and to question the necessity of pediatric cardiologist evaluation in the light of the available data. Material and Methods: All children who were admitted to Pediatric Cardiology Department of Keçiören Training and Research Hospital to get certificate to conform sports activation and underwent cardiac examination, ECG and echocardiography between October 2018 and October 2019 were enrolled in the study and findings were evaluated retrospectively. Results: A total of 785 children and adolescents with median age of 12 (minumum 5-maximum 18) years were enrolled in the study in one year period. A total of 27 (3.4%) participants showed abnormal findings on physical examination. ECG abnormalities were detected in 48 (6.1%) participants. Structural cardiac anomalies were observed in 53 (6.7%) participants by echocardiography. None of the echocardiographic diagnoses were hemodynamically significant. Conclusion: Echocardiography allows to diagnose cardiomyopathies or hemodynamically significant structural heart diseases which lead to decision of sports disqualification. However, in such a case, symptoms and ECG abnormalities may occur earlier and may be a guide for physicians for further examination. Comprehensive cardiac evaluation by a pediatric cardiologist including echocardiography should be performed in patients with suspected personal and family history, pathological findings in physical examination and/or pathological ECG findings.
Keywords: Children; electrocardiography; echocardiography; sports
Objective: Sudden cardiac death (SCD) that may occur during sports activation of young healthy athletes is a painful condition and impose responsibilities on both families and physicians. Although, there is not an established standard protocol in medical screening of sports preparticipation, any of the screening procedure cannot completely rule out the presence of cardiovascular disease and prevent from SCD. The aim of this study is to evaluate the frequency of cardiac anomalies in healthy children evaluated by electrocardiography (ECG) and transthoracic echocardiography before sports participation and to question the necessity of pediatric cardiologist evaluation in the light of the available data. Material and Methods: All children who were admitted to Pediatric Cardiology Department of Keçiören Training and Research Hospital to get certificate to conform sports activation and underwent cardiac examination, ECG and echocardiography between October 2018 and October 2019 were enrolled in the study and findings were evaluated retrospectively. Results: A total of 785 children and adolescents with median age of 12 (minumum 5-maximum 18) years were enrolled in the study in one year period. A total of 27 (3.4%) participants showed abnormal findings on physical examination. ECG abnormalities were detected in 48 (6.1%) participants. Structural cardiac anomalies were observed in 53 (6.7%) participants by echocardiography. None of the echocardiographic diagnoses were hemodynamically significant. Conclusion: Echocardiography allows to diagnose cardiomyopathies or hemodynamically significant structural heart diseases which lead to decision of sports disqualification. However, in such a case, symptoms and ECG abnormalities may occur earlier and may be a guide for physicians for further examination. Comprehensive cardiac evaluation by a pediatric cardiologist including echocardiography should be performed in patients with suspected personal and family history, pathological findings in physical examination and/or pathological ECG findings.
Keywords: Children; electrocardiography; echocardiography; sports
ÖZET
Amaç: Genç ve sağlıklı sporcuların, spor aktivitesi sırasında meydana gelebilen kaybı olarak bilinen ani kardiyak ölüm, oldukça sarsıcı bir durumdur ve hem ailelere hem de hekimlere sorumluluklar yüklemektedir. Spora katılım öncesi medikal tarama konusunda belirlenmiş standart bir protokol olmamasına karşın, görüntüleme yöntemlerinden hiçbiri, kardiyovasküler hastalık varlığını tamamen dışlayamaz ve ani kardiyak ölümden tamamen koruyamaz. Bu çalışmanın amacı, spor katılımı öncesi, elektrokardiografi (EKG) ve ekokardiografi yöntemleriyle değerlendirilen sağlıklı çocuklarda kardiyak anomali sıklığını değerlendirmek ve mevcut veriler ışığında, pediatrik kardiyolog değerlendirmesi gerekliliğini sorgulamaktır. Gereç ve Yöntemler: Çalışmaya, Keçiören Eğitim ve Araştırma Hastanesi Çocuk Kardiyoloji Polikliniğine, Ekim 2018 ve Ekim 2019 tarihleri arasında spor aktivitesine katılım raporu almak için başvuran ve kardiyolojik muayene, elektrokardiografi, ekokardiografi yapılan tüm çocuklar dahil edildi ve bulgular retrospektif olarak incelendi. Bulgular: Ortanca yaşı 12 (minimum 5, maksimum 18) yıl olan 785 çocuk ve adölesan bir yıl süre içinde çalışmaya dahil edildi. Patolojik fizik muayene bulgusu, 27 (%3,4) katılımcıda izlendi. Elektrokardiogram anormalliği 48 (%6,1) olguda saptandı. Ekokardiografi ile 53 (%6,7) olguda yapısal kardiyak anomali tespit edildi. Ekokardiyografi ile tanı koyulan kardiyak anomalilerin hiçbiri hemodinamik olarak anlamlı değildi. Sonuç: Ekokardiyografi, spora katılımda engel teşkil edebilecek hemodinamik olarak anlamlı yapısal kalp hastalığı veya kardiyomyopati teşhisine imkan vermektedir. Ancak, böyle bir durumda semptomlar ve EKG anormallikleri daha önce ortaya çıkabilir ve hekimler için ileri inceleme açısından yol gösterici olabilir. Bir pediatrik kardiyolog tarafından, ekokardiyografiyi içeren kapsamlı kardiyak değerlendirme, patolojik EKG bulguları olan ve/veya fizik muayenesinde patolojik bulgu saptanan, şüpheli kişisel ve aile öyküsü olan hastalara yapılmalıdır.
Anahtar Kelimeler: Çocuklar; elektrokardiyografi; ekokardiyografi; spor
Amaç: Genç ve sağlıklı sporcuların, spor aktivitesi sırasında meydana gelebilen kaybı olarak bilinen ani kardiyak ölüm, oldukça sarsıcı bir durumdur ve hem ailelere hem de hekimlere sorumluluklar yüklemektedir. Spora katılım öncesi medikal tarama konusunda belirlenmiş standart bir protokol olmamasına karşın, görüntüleme yöntemlerinden hiçbiri, kardiyovasküler hastalık varlığını tamamen dışlayamaz ve ani kardiyak ölümden tamamen koruyamaz. Bu çalışmanın amacı, spor katılımı öncesi, elektrokardiografi (EKG) ve ekokardiografi yöntemleriyle değerlendirilen sağlıklı çocuklarda kardiyak anomali sıklığını değerlendirmek ve mevcut veriler ışığında, pediatrik kardiyolog değerlendirmesi gerekliliğini sorgulamaktır. Gereç ve Yöntemler: Çalışmaya, Keçiören Eğitim ve Araştırma Hastanesi Çocuk Kardiyoloji Polikliniğine, Ekim 2018 ve Ekim 2019 tarihleri arasında spor aktivitesine katılım raporu almak için başvuran ve kardiyolojik muayene, elektrokardiografi, ekokardiografi yapılan tüm çocuklar dahil edildi ve bulgular retrospektif olarak incelendi. Bulgular: Ortanca yaşı 12 (minimum 5, maksimum 18) yıl olan 785 çocuk ve adölesan bir yıl süre içinde çalışmaya dahil edildi. Patolojik fizik muayene bulgusu, 27 (%3,4) katılımcıda izlendi. Elektrokardiogram anormalliği 48 (%6,1) olguda saptandı. Ekokardiografi ile 53 (%6,7) olguda yapısal kardiyak anomali tespit edildi. Ekokardiyografi ile tanı koyulan kardiyak anomalilerin hiçbiri hemodinamik olarak anlamlı değildi. Sonuç: Ekokardiyografi, spora katılımda engel teşkil edebilecek hemodinamik olarak anlamlı yapısal kalp hastalığı veya kardiyomyopati teşhisine imkan vermektedir. Ancak, böyle bir durumda semptomlar ve EKG anormallikleri daha önce ortaya çıkabilir ve hekimler için ileri inceleme açısından yol gösterici olabilir. Bir pediatrik kardiyolog tarafından, ekokardiyografiyi içeren kapsamlı kardiyak değerlendirme, patolojik EKG bulguları olan ve/veya fizik muayenesinde patolojik bulgu saptanan, şüpheli kişisel ve aile öyküsü olan hastalara yapılmalıdır.
Anahtar Kelimeler: Çocuklar; elektrokardiyografi; ekokardiyografi; spor
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