Prospective screening of 5,615 high school athletes for risk of sudden cardiac death.

Sudden cardiac death among high school athletes is a very infrequent though tragic occurrence. Despite widespread preparticipation screening for known causes of this event, the frequency has not changed. The ECG is an acknowledged sensitive screening tool for the common causes of sudden cardiac death in young athletes. The specificity of the ECG in this setting is believed to be relatively low in young athletes for which reason, in part, it is not used. We added an ECG to the usual preparticipation screening. An echocardiogram was performed when screening was abnormal. Outcome measures of serious or potentially serious cardiovascular abnormalities were defined by the 16th Bethesda Conference. These abnormalities either preclude sports participation or require further testing before approval for participation in sports can be considered. Over 3 yr, 5,615 male and female high school athletes were screened prospectively from 30 different high schools in northern Nevada. Outcome measures were detected in 22 athletes or one per 255. Cardiac history led to detection of outcome measures in 0 athletes, auscultation/inspection in 1/6,000 athletes, blood pressure measurement in 1/1,000 athletes, and the ECG in 1/350 athletes. Specificity was 97.8% for an abbreviated cardiac history and auscultation/inspection and 97.7% for ECG. Overall, the ECG was a much more effective screening tool than cardiac history and auscultation/inspection in detecting cardiovascular abnormalities requiring further tests before approval for participation in sports could be given. ECG and cardiovascular history/ausculation/inspection had similar specificity ECG was efficiently performed on large groups of high school athletes.

Coronary risk and estrogen use in postmenopausal women.

Of some 15,500 women resident in a retirement community during an 11 year interval, 220 suffered a cardiologically ascertained first myocardial infarction. A case-control study demonstrated no association between estrogen use and myocardial infarction. The observed lack of association may be explained by an already high coronary risk in this age group, by the low daily estrogen dose, and by the short duration of estrogen use. The well-known association between hypertension and myocardial infarction was confirmed.

Experience with a multidisciplinary critical care center in a community hospital.

A multidisciplinary intensive care unit has been developed in a community hospital by planning techniques which are still not common in the hospital development environment. The resulting Acute Care Center has special attributes, especially in ongoing professional educational and consultation support, in continuous physician staffing aroung the clock, in equipment and in operational policies. The net result appears to be the provision of a higher standard of patient care, a lower mortality rate for the critically ill patient, and various cost benefits. The concepts and policies involved are being met with increasing acceptance in the local medical community.