Radiation Raises Women’s Risk of Heart Disease Only Slightly, Study Finds

Story First Appeared on The Wall Street Journal

Radiation treatment for breast cancer can increase a woman’s risk of heart disease, doctors have long known. But the size of the added risk has not been clear.

Now, a new study offers a way to estimate the risk. It finds that for most women the risk is modest, and that it is outweighed by the benefit from the treatment, which can halve the recurrence rate and lower the death rate from breast cancer by about one-sixth.

According to the study, a 50-year-old woman with no cardiovascular risk factors has a 1.9 percent chance of dying of heart disease before she turns 80. Radiation treatment for breast cancer would increase that risk to between 2.4 percent and 3.4 percent, depending on how much radiation hits the heart.

“It would be a real tragedy if this put women off having radiotherapy for breast cancer,” said Sarah Darby, a professor of medical statistics at the University of Oxford in Britain, and the lead author of the study, published Wednesday in The New England Journal of Medicine.

Dr. Silvia Formenti, the chairwoman of radiation oncology at New York University Langone Medical Center, said she worried that women with cancer would misconstrue the findings to mean that radiation is dangerous and that they should have their breasts removed instead of having lumpectomies, in order to avoid radiation.

“There is a wave toward mastectomy in this country,” Dr. Formenti said.

But at the same time, she and other experts say that the cardiovascular risk is real and that when radiation is given, every effort should be made to minimize exposure of the heart.

In addition, women who have had radiation treatment need to be especially vigilant about controlling other factors that increase the odds of heart disease, like high blood pressureand cholesterol.

Dr. Lori Mosca, the director of preventive cardiology at NewYork-Presbyterian Hospital/Columbia University Medical Center, who was not involved in the study, said the findings meant that a history of breast irradiation should be added to the list of risk factors for heart disease and taken into consideration by all doctors who are treating such patients.

“We absolutely need to put on our radar screen that prior radiation to the breast may be a new and important risk factor for women,” Dr. Mosca said.

But she and other experts also warned that the results needed to be verified because the study was not a controlled experiment, but was based on an analysis of records and estimates of radiation exposure to the heart.

Dr. Javid Moslehi, co-director of the cardio-oncology program at the Dana-Farber Cancer Institute in Boston and the author of an editorial accompanying the study, said the research was the first to provide risk estimates correlated with doses in breast cancer treatment, over a long time period.

“This is a huge paper, both in terms of how many women it impacts, and how it opens the door for new studies that need to be done,” Dr. Moslehi said.

He said the study reflected the fact that many people with cancer are now living long enough to encounter long-term effects of both radiation and chemotherapy.

They have given rise to a new and fast-growing field in medicine, cardio-oncology.

About three million women in the United States have been treated for breast cancer, and the majority have had radiation.

Although doctors try to spare the heart, it still gets some of the dose, especially when the left breast is treated. Radiation can damage the linings of blood vessels and scar the heart muscle.

Dr. Darby’s study is based on the records of 2,168 women who had radiation for breast cancer from 1958 to 2001 in Sweden and Denmark; 963 of the women had “major cardiac events” sometime after their cancer treatment, meaning a heart attack or clogged coronary arteries that needed treatment or caused death.

From the treatment records, the researchers estimated the radiation dose to the women’s hearts. They found that the risk began to increase within a few years after exposure, and that it continued for at least 20 years. The higher the dose, the higher the risk, and there was some increase in risk at even the lowest level of exposure.

“It was certainly a surprise to us that the risk started within the first few years after exposure, as radiation-related heart disease has traditionally been thought of as usually occurring several decades after exposure,” Dr. Darby said.

Radiation is measured in units called Grays, and the researchers found that for each Gray to which the heart was exposed, the odds of heart attack or another coronary events rose by 7.4 percent. The average dose to the heart over an entire course of radiation treatment was 5 Gray, they said. For an individual woman, the net effect would depend on her baseline initial risk of heart disease and the total radiation dose to her heart.

Women who already had risk factors, especially those who had had heart attacks in the past, would have seen the largest absolute risk from radiation.

Some radiation oncologists say that nowadays, the dose to the heart is lower than 5 Gray.

Dr. Louis S. Constine, vice chairman of radiation oncology at the University of Rochester Medical Center, said that 2 Gray was more common and that doctors could now put shields in front of the heart and “curve radiation around the chest wall instead of shooting it through the heart and lungs.”

Dr. Formenti thinks that for most patients, the best way to protect the heart is to treat them while they are lying on their stomachs, instead of the usual way, lying on their backs. Women lie on a table or a mattress with openings that let the breasts drop away from the chest.

Anatomy differs, but in most women this prone position helps keep the radiation beams as far as possible from the heart and lungs. The heart still receives some radiation, but significantly less than when women lie on their backs, especially when the left breast is being treated.

“If you can keep it below 1 Gray, which is what we are doing, you are probably O.K. with the majority of patients,” Dr. Formenti said.

During the past 15 years, she said, she has treated several thousand patients this way.

Dr. Formenti and her colleagues also teach the technique to other doctors. But, she said, it is taking a long time to catch on.

Heart Health ABC's

Story first appeared on ABC News -

With more than 2 million heart attacks and strokes each year, and 800,000 deaths, according to the Centers for Disease Control and Prevention, cardiovascular disease is the leading cause of death for both men and women in the United States. One out of every three deaths is from heart disease and stroke.

These conditions are also the leading causes of disability, and they're costing this country a fortune -- together, heart disease and stroke hospitalizations in 2010 rang up $444 billion in health care expenses and lost productivity, according to the CDC.

It's the rare American who hasn't been touched by heart disease in some way. Just about all of us have known someone who has had cardiovascular illness, a heart attack or stroke. Heart problems can strike older folks, middle-agers, high schoolers, children -- even babies. No ethnicity is immune. And heart disease strikes people from all walks of life, famous or not.

But we can fight back against this scourge. Awareness is key.

Heart Related Deaths Drop for Diabetics

Story first appeared in The Daily Disruption.

Death rates for people with diabetes dropped substantially from 1997 to 2006, especially deaths related to heart disease and stroke, according to researchers at the Centers for Disease Control and Prevention and the National Institutes of Health.

Deaths from all causes declined by 23 percent, and deaths related to heart disease and stroke dropped by 40 percent, according to the study published today in the journal Diabetes Care. Scientists evaluated 1997-2004 National Health Interview Survey data from nearly 250,000 adults who were linked to the National Death Index. Although adults with diabetes still are more likely to die younger than those who do not have the disease, the gap is narrowing.

Improved medical treatment for cardiovascular disease, better management of diabetes, and some healthy lifestyle changes contributed to the decline, according to accredited Allen Park Heart Doctors. People with diabetes were less likely to smoke and more likely to be physically active than in the past. Better control of high blood pressure and high cholesterol also may have contributed to improved health.  However, obesity levels among people with diabetes continued to increase.

Taking care of your heart through healthy lifestyle choices is making a difference, but Americans continue to die from a disease that can be prevented. Although the cardiovascular disease death rate for people with diabetes has dropped, it is still twice as high as for adults without diabetes.

Experts specializing in Allen Park Stroke Care have shown that previous studies have found that rates of heart disease and stroke are declining for all U.S. adults. Those rates are dropping faster for people with diabetes compared to adults without diabetes.  Recent CDC studies also have found declining rates of kidney failure, amputation of feet and legs, and hospitalization for heart disease and stroke among people with diabetes.

Because people with diabetes are living longer and the rate of new cases being diagnosed is increasing, scientists expect the total number of people with the disease will continue to rise. The number of Americans diagnosed with diabetes has more than tripled since 1980, primarily due to type 2 diabetes, which is closely linked to a rise in obesity, inactivity and older age. CDC estimates that 25.8 million Americans have diabetes, and 7 million of them do not know they have the disease.

CDC and its partners are working on a variety of initiatives to prevent type 2 diabetes and to reduce its complications. CDC leads the National Diabetes Prevention Program, a public-private partnership designed to bring evidence-based programs for preventing type 2 diabetes to communities. The program supports establishing a network of lifestyle-change classes for overweight or obese people at high risk of developing type 2 diabetes.

Diabetes carries significant personal and financial costs for individuals, their families, and the health care systems that treat them. As the number of people with diabetes increases, it will be more important than ever to manage the disease to reduce complications and premature deaths.

Controlling levels of blood sugar (glucose), cholesterol and blood pressure helps people with diabetes reduce the chance of developing serious complications, including heart disease, stroke, blindness and kidney disease. Controlling these levels at home is simple with devices such as the Accu-Trend Plus Self-Testing Diabetes Monitor.

In 2001, the National Diabetes Education Program (NDEP), a joint effort of CDC and NIH with the support of more than 200 partners, developed a campaign to raise awareness of the link between diabetes and heart disease and reinforce the importance of a comprehensive diabetes care plan that focuses on the ABCs of diabetes – A1C (a measure of blood glucose control over a two- to three-month period), Blood pressure and Cholesterol. 

Last year CDC and the Centers for Medicare & Medicaid Services launched Million Hearts, an initiative to prevent 1 million heart attacks and strokes over the next five years.  The initiative focuses on two main goals: empowering Americans to make healthy choices and improving care for people, focusing on aspirin for people at risk, blood pressure control, cholesterol management and smoking cessation. More than 2 million heart attacks and strokes occur every year, and treatment for these conditions and other vascular diseases account for about 1 of every 6 health care dollars, say Allen Park Cardiologists.  Up to 20 percent of deaths from heart attack and 13 percent of deaths from stroke are attributable to diabetes or pre-diabetes.

Diabetes was the seventh leading cause of death in 2009 and is the leading cause of new cases of kidney failure, blindness among adults younger than 75, and amputation of feet and legs not related to injury. People with diagnosed diabetes have medical costs that are more than twice as high as for people without the disease. The total costs of diabetes are an estimated $174 billion annually, including $116 billion in direct medical costs.

For more Health News, visit the Healthcare and Medical News blog.

For more national and worldwide Business News, visit the Peak News Room blog.

For more local and state of Michigan Business News, visit the Michigan Business News blog.

For more Electronics News, visit the Electronics America blog.

For more Real Estate News, visit the Commercial and Residential Real Estate blog.

For more Law News, visit the Nation of Law blog.

For more Advertising News, visit the Advertising, Marketing and Media blog.

For more Environmental News, visit the Environmental Responsibility News blog.

For information on website optimization or for the latest SEO News, visit the SEO Done Right blog.

Simple Test for Babies to Determine Heart Problems

Story first appeared in the Detroit Free Press.

It's a simple test, but it can make a life or death difference for newborns with a previously undiscovered heart defect. Pulse oximetry in infants -- a variation of the finger-clip test many Americans get to determine whether the heart is pumping blood effectively -- is being added in U.S. hospitals -- including a dozen in Michigan -- as a common newborn screening tool.

There's also a push here and in other states to pass laws, as Indiana and Maryland have, to require the test, according to a support group, PulseOx Advocacy, which tracks the issue on its website.

A lot of newborns can be discharged without knowing they have significant problems with the heart. Each year, between 4 and 10 out of every 1,000 children born in the United States will have a congenital heart defect. Of those, more than 1,500 won't live to have a first birthday, according to the American Heart Association.

Fortunately, detection tools have improved so much that many of the problems are found by fetal ultrasound tests during pregnancy or during exams by pediatricians after birth. For those that are not found prior to birth, pediatric pulse oximeters make the difference.

One baby of 14,017 tested at the University of Michigan between 2006 and 2010 was diagnosed through pulse oximetry testing with a heart problem that otherwise would have gone undetected.

U-M has routinely offered the newborn screening since 2003 because it saw a benefit to the tests and, as a teaching hospital, had pediatric cardiologists readily on staff. Michigan doctors are working with the Michigan Department of Community Health to create a statewide system so that babies born at hospitals without pediatric cardiologists get the right, immediate follow-up if they flunk a pulse oximetry test showing that their hearts don't pump oxygen effectively.

In a smaller community hospital, we need to make sure cardiologists are available to see patients.

Most of the 60 Michigan hospitals that deliver babies have fewer than 1,000 births a year and of those, half have fewer than 500 births -- places unlikely to have pediatric cardiologists on staff.

Michigan applied for a $300,000 federal grant to gather statistics about the screening and follow-up tests and treatment.

The project also will look at whether there are more inaccurate readings -- usually suggesting a problem that isn't there -- if the pulse oximetry test is performed after the first day of life, as is done in England without big problems.

2-minute test
Over the past few months -- and as recently as last week -- metro Detroit hospitals adding the test include Hutzel Hospital, Detroit; St. John Providence, Southfield, and St. Joseph Mercy Oakland, Pontiac, according to doctors and hospital spokespersons.

Others expect to start soon, including the Oakwood Healthcare system in Dearborn, St. Mary of Livonia and Beaumont Health System based in Royal Oak, spokespersons said.

Pulse oximetry is best at finding heart defects that result from poor oxygen circulation in the blood. It's usually performed 24 hours after a baby is born -- while most infants still are in the hospital. If the test picks up something suspicious, it often is repeated once or twice within the next few hours.

It's recommended that babies discharged before 24 hours after birth get the test within a few days at their pediatrician's office.

The tests take about two minutes. Sensors are attached with tape to a baby's hand and foot. St. John Hospital spent $16,900 to buy new motion-resistant machines for its labor and delivery unit.

Proponents hope to get the Michigan Lt. Governor to help push for mandatory testing. His then-15-month-old daughter underwent open-heart surgery last May for a congenital heart defect.

The Lt. Governor who has another child with autism, played a similar role recently in the passage of legislation to require insurance coverage for autism care.

For now, the Michigan Governor's office said it will review any legislative proposals and is working with hospitals to develop a coordinated system.

Push for a testing law

Several local groups, including Hearts of Hope, support a state testing law involving pediatric pulse oximeters.

A  Royal Oak woman's son, now 3 1/2, was born with a hole in his heart and a narrowing of a key valve and artery. The condition left him too weak to breastfeed. After he lost a pound of his birth weight and continued having nursing problems, she brought him to his pediatrician, who recommended he see a pediatric cardiologist.

When the diagnosis came, it was like the air shifted in the room.

He had heart surgery when he was just 9 months old. Today, he's doing fine, loves his gymnastics class and calls his younger brother his best friend. His long chest scar is nearly gone and he has stretched his follow-up appointments with a Beaumont pediatric cardiologist to every two years.


For more healthcare and medical related news, visit the Healthcare and Medical blog.
For national and worldwide related business news, visit the Peak News Room blog.
For local and Michigan business related news, visit the Michigan Business News blog.
For law related news, visit the Nation of Law blog.
For real estate and home related news, visit the  Commercial and Residential Real Estate blog.
For technology and electronics related news, visit the Electronics America blog.
For organic SEO and web optimization related news, visit the SEO Done Right blog.

Family History May Be Key in Heart Risk

First appeared in the Wall Street Journal

Ecorse Heart Doctors often gloss over a key question for assessing a person's risk for coronary heart disease, according to a new study: What is the patient's family history of cardiovascular illness?

The study suggests some doctors may not be capturing the full extent of many patients' chances of developing heart disease. Detailed family information could help doctors better predict who is at risk and more accurately target patients for preventive care that may help avert the disease altogether, according to the study, due to be published Tuesday in the Annals of Internal Medicine. Routinely tracking family history sharply boosted the number of people in the study considered at high risk for heart disease.

A widely used scorecard for measuring heart risk, the Framingham Risk Score, fails to take family history directly into account. And while many doctors currently collect some information about the health of their patients' families, the data often lack the detail to be clinically useful for assessing risk and prescribing care.

Family history remains one of the most important predictors of an event for an individual. Still, most of the family history that experts are collecting is just the presence or the absence of heart disease, not the age of onset or the type of disease, according to Northville Cardiologists.

Guidelines for heart-risk screening, issued by the heart association in late 2010, encouraged doctors to take family histories into account. Doctors sometimes make judgment calls to treat people as high risk because of family history, even if it isn't part of the patient's risk score.

The study, funded by the United Kingdom Department of Health, included 748 patients aged 30 to 65. Up to 13% of patients were found to be at high risk of coronary heart disease using traditional assessment tools. After patients filled out enhanced questionnaires that sought more complete information, the percentage considered at high risk jumped to 18%. The traditional assessment could include general information, such as blood pressure, cholesterol level and basic information about whether a family member had a history of heart disease. The enhanced survey would identify, for instance, that a patient's mother had a heart attack at age 50.

It's a low cost way to target people who are at high risk for cardiovascular disease, say Romulus Heart Doctors.

Findings from the U.K.-based study reflect similar use of family history among doctors in the U.S., several U.S.-based physicians say.

Family history has been linked to higher risk for a number of illnesses, including cancer and diabetes. Unlike some other diseases, however, clear genetic markers for coronary heart disease, which accounts for 1 in 6 U.S. deaths, remain elusive. Family histories can be used as a proxy for detailed genetic work that may someday be used to help predict heart-disease risk, researchers say.

Another risk-measurement tool, known as the Reynolds Risk Score, developed by Harvard University researchers in the 1990s, does consider if a patient's parent had a heart attack and at what age. However, many medical practices don't yet use the tool, which became available in 2007.

Using the Reynolds system, the researchers tracked 25,000 initially healthy patients over a decade. They found that a 50-year-old male patient who, among other things, smoked, and had high blood pressure and cholesterol, but no family history of heart disease, had a 12%, or moderate, chance of having a heart attack in the 10-year period. But a similar patient with a parent who had a heart attack before age 60 had a 20% risk, putting that patient at high risk for heart disease. Heart risk wasn't significantly affected in patients with a parent who had a heart attack at the age of 60 or older.

Still, many medical practices continue to rely on the older Framingham Risk Score, which became available in the 1990s. Researchers believed that other factors, including blood pressure and cholesterol levels, provided all the information needed to determine a patient's risk for heart disease.

Doctors use the scoring systems to single out patients who could benefit from counseling about lifestyle changes, such as losing weight and quitting smoking, or from preventive interventions such as low-dose aspirin and cholesterol drugs, says Yul Ejnes, the chairman of the American College of Physicians board of regents. The college publishes the Annals of Internal Medicine.

Primary-care doctors say there are obstacles to gathering family histories from patients, including competing priorities for time in the examination room. And patients often don't know many details about their family members. In the Annals of Internal Medicine study, patients were mailed questionnaires and instructed to gather the material before seeing their doctor.

Patients should make a point of knowing the health histories of their parents, siblings and grandparents, he says. To identify clues about specific diseases, however Riverview Heart Doctors say that they sometimes asks patients questions like: "What do you remember about Grandpop's hospitalization? Were his legs swollen?"

A 33-year-old a senior marketing director at a Boston technology firm, says her family history has made her an advocate for her own health. She says she watches her diet and exercises regularly. And although she currently isn't on any heart medication, she regularly pushes her doctor to check thoroughly for signs of developing heart disease.

For more Health News, visit the Healthcare and Medical News blog.

For more national and worldwide Business News, visit the Peak News Room blog.

For more local and state of Michigan Business News, visit the Michigan Business News blog.

For more Electronics News, visit the Electronics America blog.

For more Real Estate News, visit the Commercial and Residential Real Estate blog.

For more Law News, visit the Nation of Law blog.

For more Advertising News, visit the Advertising, Marketing and Media blog.

For more Environmental News, visit the Environmental Responsibility News blog.

For information on website optimization or for the latest SEO News, visit the SEO Done Right blog.

THE NUMBER ONE KILLER FOR WOMEN IS HEART DISEASE

Heart disease can sneak up on women in ways that standard cardiac tests can miss.

It's part of a puzzling gender gap: Women tend to have different heart attack symptoms than men. They're more likely to die in the year after a first heart attack.

In fact, more than 40 percent of women still don't realize that heart disease is the No. 1 female killer. One in 30 women's deaths in 2007 was from breast cancer, compared to about 1 in 3 from cardiovascular disease.

A new report says there's been too little progress in tackling the sex differences in heart disease. It outlines the top questions scientists must answer to find the best ways to treat women's hearts - and protect them in the first place.

Make no mistake: Heart disease is the leading killer of men, too. The illness is more prevalent in men, and tends to hit them about a decade earlier than is usual for women.

But while overall deaths have been dropping in recent years, that improvement has been slower for women who face some unique issues.

Sure, being a couch potato and eating a lot of junk food is bad for a woman's heart just like a man's. High cholesterol will clog arteries. High blood pressure can cause a stroke, say specialists at an Ecorse Stroke Care center.

But here's one problem: Even if a test of major heart arteries finds no blockages, at-risk women still can have a serious problem - something called coronary microvascular disease that's less common in men. Small blood vessels that feed the heart become damaged so that they spasm or squeeze shut.
Specialists who suspect microvascular disease prescribe medications designed to make blood vessels relax and blood flow a bit better, while also intensively treating the woman's other cardiac risk factors. But it's not clear what the best treatments are.

The report says part of the lack of understanding about such gender issues is because heart-related studies still don't focus enough on women, especially minority women. Only a third of cardiovascular treatment studies include information on how each gender responds even though federal policy says they should. Some Lincoln Park Heart Doctors urge direct comparisons of which treatments work best in women, and improved diagnostic tests.

Another issue: Even young women sometimes have a heart attack, and there are troubling hints that their risks are rising. There's been a small uptick in deaths among women younger than 45. Plus, high blood pressure, diabetes or related complications during pregnancy - a growing worry as more women start their pregnancies already overweight - aren't just a temporary problem but increase those mothers' risk of heart disease once they reach middle age. The report says too few doctors are aware they should consider that.

Then there are the questions of how best to tell which women are at high risk. Nearly two-thirds of women who die suddenly of heart disease report no previous symptoms, for example, compared with half of men. As for heart attacks, chest pain is the most common symptom but women are more likely than men to experience other symptoms such as shortness of breath, nausea and pain in the back or jaw.

Legislation pending in Congress would require better study of gender differences, and would expand a government program that currently screens poor women in 20 states for high cholesterol and other heart risks, offering smoking cessation and nutrition education to help lower those risks. Groups, which receive some funding from drug companies, and the heart association support the bill.
One young patient says women need to know more about heart disease - and to get pushy about any symptoms.

One woman of New Orleans was just 30 and seemingly healthy when she started getting short of breath and feeling a flutter in her chest during her daily workouts. Her primary care doctor thought it was panic attacks. Garden City Cardiologists found no obvious risk either - her cholesterol and blood pressure were normal - but ordered a stress test that signaled her heart fears were right. A further exam found severe blockages in two arteries that required stents to prop open.

Now 37, she says doctors' best guess is that a stressful lifestyle - a single mother, a full-time job, a part-time personal trainer, and studying for an advanced degree all at the same time - left her vulnerable even without obvious risk factors. Had she not been so fit, they said, her heart might not have held out as long before symptoms appeared. She's learned to be more laid-back, along with a healthier diet and keeping up that exercise.

For more Health News, visit the Healthcare and Medical News blog.

For more national and worldwide Business News, visit the Peak News Room blog.

For more local and state of Michigan Business News, visit the Michigan Business News blog.

For more Electronics News, visit the Electronics America blog.

For more Real Estate News, visit the Commercial and Residential Real Estate blog.

For more Law News, visit the Nation of Law blog.

For more Advertising News, visit the Advertising, Marketing and Media blog.

For more Environmental News, visit the Environmental Responsibility News blog.

For information on website optimization or for the latest SEO News, visit the SEO Done Right blog.

Is it Safe for Students to Play Sports without Heart Exams?

USA Today

Most teenagers think they're invincible, and that goes double for talented teenage athletes. They're young, immortal, at the top of their game, the envy of their friends.

So when news hits that an apparently healthy, high school or college athlete has dropped dead in the midst of playing his or her favorite sport, millions of parents get understandably anxious.

The uppermost question becomes: Should my child be screened before participating in sports? What tests are needed? And how can we be sure that he or she is truly healthy enough to compete?

Everyone agrees that a medical checkup before participating in sports is crucial. But the agreement seems to stop there. At the core of the conflict over further testing is how extensively young athletes' hearts should be tested before they're cleared for athletic participation, say Livonia Heart Doctors.

Everyone should have a doctor who evaluates them, and the doctor should know the child is going to be participating in athletics.

That statement recommends cardiovascular screening for high school and college athletes before they start participating in athletics and at two- to four-year intervals. The screening should include a family history, a personal history and an exam "focused on detecting conditions associated with exercise-related events," according to a Lincoln Park Cardiologists recommendation.

But, there's more: "The AHA does not recommend routine, additional noninvasive testing such as a routine EKG (electrocardiogram, which assesses the heart's electrical rhythms)."

The American Academy of Pediatrics seems to agree. "Every athlete should have a thorough history (taken) from the athlete as well as the athlete's family," explained Dr. Reginald Washington, a pediatric cardiologist and chief medical officer at Rocky Mountain Hospital for Children in Denver and past chairman of the academy's committee on sports medicine and fitness.

The doctor should ask about any chest pain and dizziness, and whether the athlete has ever passed out or experienced a racing or unusual heartbeat, Washington said. The physician should also ask if the athlete's parents have had early heart disease, before age 55 for a man and 65 for a woman. And the physical exam, he said, should be thorough and include listening to the heart, taking blood pressure and feeling the pulse.

"If all of that is normal and the family history is normal, no further tests need to be done," said Washington, echoing the academy's stand.

But others disagree strongly, calling for universal and extensive testing of all young athletes to avert future tragedy.

Melvindale Heart Doctors and other experts contend that both an EKG and an echocardiogram — which is an ultrasound that measures heart size, pumping function and checks for faulty heart valves — are crucial to detect early signs of heart defects in young athletes because neither test alone will catch all potential problems.

In testing 134 high school athletes competing in the Maryland state track and field championships in 2008, for instance, no life-threatening heart defects were found but blood pressure abnormalities that required further testing and monitoring were detected in 36 athletes, some by EKG and some by echocardiogram, the Hopkins doctors reported at an American Heart Association session in late 2009.

Testing in 2009, according to a Hopkins report, found a serious heart valve disease in one track-and-field athlete and another with an undiagnosed heart condition that could require a transplant in the future. Neither athlete had reported any symptoms.

"If you are going to screen, it has to be comprehensive," Dr. Theodore Abraham, an associate professor at Hopkins' School of Medicine and its Heart and Vascular Institute, said in a prepared statement.

Other studies have found pros and cons to extra screening.

For instance, Harvard researchers who looked at 510 college athletes found that screening with a history and physical exam alone has an overall sensitivity of 45.5%, meaning it would find existing problems in about 45 of every 100 athletes screened. But adding an EKG to the screening boosted it to more than 90%.

However, the EKGs were also linked with a false-positive rate — suggesting a problem when none existed — of nearly 17%, according to their report, published March 2 in the Annals of Internal Medicine.

A separate study in that issue, on the cost-effectiveness of such screenings, reported that adding EKGs to screenings of young athletes saves two years of life per every 1,000 athletes, at a per-athlete cost of $89.

Screening policies differ from region to region across the country. In Houston, for instance, athletic trainers at 10 high schools are using laptop systems to give young athletes EKGs, and a doctor in the city has launched a program to provide heart screening to all sixth-graders, eventually hoping to screen all sixth-graders in Texas.

But there are downsides to such universal screening, others say.

"About 10% of kids who get EKGs are thought to have something the matter with them by the EKG," Thompson, the Connecticut doctor, said. "That drives additional testing, and nearly all don't have anything wrong."

The problem, he said, is not just wasted health-care dollars but the anxiety caused by additional testing, for athletes and their parents.

Thompson said he is not oblivious to parental worry or to the sad reality that some athletes die unexpectedly each year.

"Every single one of these deaths is an incredible tragedy," he said, adding that he will do extra testing if parents are very worried. "But when people have looked at this, the death rate in the U.S. is about one in every 250,000 athletes. There is not really conclusive research to show (extensive testing) saves lives."

Also, in mass screenings — where kids line up and are screened quickly — accuracy may suffer, said Detroit heart doctors. "A good, thorough ultrasound should take a half-hour," he said. "If you line up all the kids (at a school or on a team) to have a portable ultrasound, you will miss some of these subtle abnormalities."

But Sharon Bates, a parent who founded the Anthony Bates Foundation after her athlete son, Anthony, died unexpectedly in 2000 and was found to have had an enlarged heart, disagrees with the arguments against mass screenings.

Even if a problem picked up is minor, she said, you have a right to know, and it needs to be addressed.

Bates's son had passed the typical pre-athletic physical at Detroit heart center with flying colors, she said, yet he still had a major cardiac problem.

Her Phoenix-based foundation promotes universal screenings for all youth, not just athletes, she said.

As Abraham said, "What is the price for a single life?"

For more Health News, visit the Healthcare and Medical News blog.

For more national and worldwide Business News, visit the Peak News Room blog.

For more local and state of Michigan Business News, visit the Michigan Business News blog.

For more Electronics News, visit the Electronics America blog.

For more Real Estate News, visit the Commercial and Residential Real Estate blog.

For more Law News, visit the Nation of Law blog.

For more Advertising News, visit the Advertising, Marketing and Media blog.

For more Environmental News, visit the Environmental Responsibility News blog.

For information on website optimization or for the latest SEO News, visit the SEO Done Right blog.