WHAT IS THE HEART SAFE PHYSICAL?

The Heart Safe™ Physical consists of the basic exam that is conducted in a typical physical PLUS an electrocardiogram (EKG) and, if necessary, a focused echocardiogram, using a portable ultrasound device, which can detect enlarged hearts and electrophysiological abnormalities that can lead to Sudden Cardiac Death (SCD).

 

 

WILL AN INDIVIDUAL STILL BE ABLE TO PARTICIPATE IN STRENUOUS ACTIVITY IF THE EXAM DETECTS A HEART CONDITION?

A physician or cardiologist must determine an individual's level of physical activity.

 

 

WHAT CAUSES OF SCD DOES THE HEART SAFE™ PHYSICAL DETECT?

Hypertrophy of the left ventricle (HCM), dilation of the left ventricle and overt electro physiologic abnormalities such as Long QT Syndrome.

 

 

WHAT IS HCM?

Hypertrophic Obstructive Cardiomyopathy (HCM or HOCM) is a genetic condition where the heart muscle enlarges (hypertrophy of the left ventricle), blocking blood flow from the heart. The blockage causes the heart to lose oxygen, which can result in sudden cardiac arrest.

 

 

IF HCM IS FAIRLY RARE WHY SHOULD STUDENTS BE TESTED FOR IT?

HCM is the leading cause of SCD under age 24. While about 1 in 200,000 people will die of HCM every year, many more people have the condition but are unaware (about 1:500 have the trait). Trying to detect HCM is one of the primary purposes of health physicals for athletes. However, traditional sports physicals have not done a good job of detecting HCM, which is why the Heart Safe™ Physical includes an EKG and echocardiogram when appropriate.

 

WHY DOES THE AMERICAN HEART ASSOCIATION NOT RECOMMEND WIDESPREAD TESTING FOR HCM?

 

The AHA is a wonderful organization that would like better screening. But they believe the best test, an echocardiogram, is too expensive (eg. $500 - $2,000). They are concerned that electrocardiograms (EKG), which are cheaper, have a high false positive rate. The high false positive rate means that more people would be sent for an echocardiogram when unnecessary, causing a financial burden on the health care system. Our solution is to provide both the EKG and echo at a cost that is less than the cost of most physicals without heart screening, thereby eliminating concerns about taxing the health care system while protecting children.

 

 

What are the Symptoms? Some people experience shortness of breath, chest pains or fainting, but typically HCM presents no symptoms so the condition is not discovered until a health crisis or death occurs. Exertion from sports, running or other physical activity can exacerbate the condition, leading to sudden cardiac death.

 

HOW IS HCM TREATED?

Treatment for HCM varies by individual. A physician should be contacted immediately if you or a family member are experiencing symptoms.

 

 

WILL THE HEART SAFE™ PHYSICAL DETECT ALL CAUSES OF SCD?

No, unfortunately there is no way to detect all causes of SCD. Our exam focuses on hypertrophy of the left ventricle. Myopathies of the left ventricle are associated with about 44% of the causes of SCD. This is the largest associational parameter associated with SCD. However, using a quote from the 2007 American Heart Association pre-participation guideline, "some diseases are beyond detection with any mass screening strategy, even when diagnostic testing is in expert hands. For example, definitive documentation congenital coronary artery anomalies of wrong sinus origin (most commonly, left main coronary from right sinus of Valsalva) usually requires sophisticated laboratory examination, ie., coronary arteriography, transesophageal echocardiography, cardiac magnetic resonance imaging, or computed tomography angiography. However, on occasion, it is possible to identify or raise the suspicion of anomalous left coronary artery with standard transthoracic echocardiography. Also, many cardiovascular abnormalities must be distinguished from the physiological and benign profile of athlete's heart."

 

 

HOW ARE RESULTS REPORTED?

Students released to play sports will be given a signed form to turn in to the school. Students not released to play will be notified by the cardiologist and referred to their personal physicians for further examination and recommendations. The school will be notified if the student or parent gives consent to release the information.

 

CAN A STUDENT JUST GET THE PHYSICAL AND SKIP THE HEART SCREENING?

No, the heart screening is critical to detecting conditions that can lead to sudden cardiac death. Students are allowed to get the heart screening without the physical.

 

HOW LONG DOES THE EXAM TAKE?

The exam takes 7-10 minutes.

 

WILL THE HEART SAFE PHYSICAL INCREASE COSTS?

1. Very slightly and with a much higher value–the reason for a slightly higher cost is the addition of two very accurate tests, the EKG and focused echocardiogram. Even with the additional tests, the cost of the heart safe physical is about the same price as a physical without these tests. For example

  A school physical normally costs $25-$75.

   An EKG done in a physician office or hospital can typically cost > $100.

   A focused echocardiogram can cost > $400.

  

2.     We provide all three tests for under $50.

 

 

HOW IS THE HEART SAFE PHYSICAL (HSP) BETTER THAN THE CURRENT PHYSICAL EXAM?

1.     The heart safe scan does everything a typical schools physical does, plus adds two very accurate heart specific tests, i.e. an electrocardiogram and focused echocardiogram.

2.     The heart safe scan electrocardiogram and echocardiogram are interpreted by a board certified pediatric cardiologist.

3.     The HSP is done at the school, avoiding the inconvenience of driving to a separate health facility.

• A school physical normally costs $25-$75.

4.     Current physical exams may give a false sense of security to the parent, student and school. All the students who have died during physical sports had a physical, some just shortly prior to their death. The HSP will detect the majority of causes of sudden cardiac death, unlike a physical.

 

 

DOES THE HSP REPLACE THE PEDIATRICIAN EXAM?

No. This exam provides your pediatrician additional information that often is not available, due to the expense of EKG’s and focused echocardiograms.

 

 

WILL THE RESULTS BE FORWARDED TO MY DOCTOR?

Yes. All results will be forwarded to your physician.

 

WHO PERFORMS THE EXAM?

A nurse practitioner or a physician performs the physical and EKG. Echocardiograms are performed by certified sonographers and read by a board certified pediatric cardiologist.

 

DOES THE EKG OR ECHO HURT?

Both tests are painless and noninvasive.

 

CAN PARENTS BE WITH THEIR CHILDREN DURING THE EXAM?

Yes, parents are welcome to accompany their children.

 

DOES CLOTHING HAVE TO BE REMOVED?

No. However, students will need to lift their shirt/blouse up a little to have the EKG and echocardiogram performed. All exams will be conducted in private areas.

 

WHAT DOES THE EXAM NOT DETECT?

·       Coronary artery anomalies

·       Myocarditis

·       Coronary artery disease

·       Sarcoidosis

·       Aortic rupture

·       Ion channelopathies

·       Tunneled LAD

·       Congenital heart disease

·       ARVC

·       Commotio cordis