Scott Webb (Host): This is Children's Health Checkup, where we answer parents' most common questions about raising healthy and happy kids. I'm Scott Webb, and today we're talking about heart health in young athletes, and our expert, Dr. Katherine Hansen is a Pediatric Cardiologist and Director of the Exercise and Sports Cardiology Program at Children's Health.

And we're going to discuss how sports and physical activity are great for overall health and some of the unique challenges and risks young athletes could face when it comes to their hearts.

Doctor, it's so nice to have you here today. I was just mentioning briefly that I have a daughter, she's 17. She's an athlete. So it's great to have you here. Great to have your expertise. And, I think one of the sort of things that we all do, we tend to assume, right, with young athletes that they're healthy because they're young and they look healthy, and they're active in sports, but are there some misconceptions about heart health in young athletes? Are there things that maybe we might be missing?

Katherine Hansen, MD: Since you mentioned your daughter, I have an athletic background too, and I took so many wonderful things away from sports. So just to say that out loud, I have a bias towards sports for sure. And I think that's because at its best, sports participation is one of the best ways to help children and teens learn to develop body confidence, body competence.

And also develop structure around exercise so that it's a daily habit. And so many other reasons. They learn important life skills related to goal setting, and hard work, and teamwork, and I think one of the most important things is hopefully it's a way that they learn that exercise can be fun. And there's so much evidence for how sports participation is great for cognition, school performance, sleep, psychosocial health, and of course, kids who are more active are generally more fit.

I will say that not all sports and the opportunities that come with sports are created equal, so just because the kid is on a sports team doesn't mean that they're getting the one hour of moderate to vigorous physical activity most days, which pretty much all major guidelines recommend for teens. You know, it kind of depends on the sport, depends on the position, depends on the child's kind of engagement with, with the team.

So I do think, though, of these teenage years as being a really important formative time, an important opportunity for kids to build habits for life. So, you know, when we're thinking about the role of parents in all of this, just like teaching your kid that brushing their teeth is important to do every day, I think, you know, using kind of sports as a way to teach them that doing physical activity and exercise on a daily basis is, is essential, too.

But I think more to the kind of question you were getting at is on the other end of the spectrum, you can have a very athletic teen and they might have a heart condition. I mean, that, that certainly can happen. You can be fit, but also have something under the surface, like a genetic or congenital heart issue that can put you at risk for a sudden cardiac event.

Despite this being, you know, pretty highly publicized when these, these events happen on a sports field, for example, they're so rare. And really these sports participation screening forms and, you know, and when a high school athlete sees their pediatrician before they start their sports season, that's really what that's there for, is to screen for these rare conditions.

So I think it is important for parents to do their best to know family history and pay attention to symptoms that a child might have. Um, we'll get into this a little bit later, but things like chest pain, fainting, near fainting during exercise, those are things to ask your doctor about. And then I just want to put a plug that the other really important thing we can do from a public health perspective is for everyone to learn CPR and for there to be an emergency preparedness plan in place for sporting events.

And that includes having accessible AEDs or the automatic automated external defibrillators available.

Host: I was telling you that I just hosted a similar podcast recently, and we talked a lot about that, about more folks knowing CPR, about how much more accessible AEDs are now than they used to be back in the day, back in my day, you know. This particular high school district requires that all graduating seniors know CPR as a condition of graduation.

Which I just thought was amazing because, you know, you just never know. The old days, doctor, you know, is there a doctor in the house? There may not be a doctor in the house, but there could be somebody there, even a teenager who knows CPR, right?

Katherine Hansen, MD: Right. I mean, I think this is one of the most important things, if not the important thing that we can do is teach people how to respond in the case of a sudden cardiac event so that, you know, it's not just the athletes on the sports field, but if you're at the grocery store and an elderly person goes down. There's a lot of scenarios where there's a cardiac event, and having AED's available, having people who know how to do CPR; it's incredible the improvement in outcomes in terms of, you know, people's recovery for their heart, but also for the brain after a big event like that. So, I can't say enough about the importance of that. So I think it's great that some of the schools are moving towards having that be part of the kind of graduating requirement.

So really important. But I also would say that just because you have an AED on site is not necessarily enough. You have to have an emergency preparedness plan around how to access that, making sure people know where it is. There's all kinds of examples where the AED is like in some locked cabinet where no one can get to it when they need to.

So, gotta make sure it's accessible,

Host: Yeah. You got to have a plan, make sure it's accessible, that the folks there know how to use it, all that good stuff. Just want to talk about some of the common heart health issues that could affect young athletes. You know, you mentioned knowing your family history and genetics, that being sort of a part of it, but what are some of the things that we should be on the lookout for? Some of the issues anyway.

Katherine Hansen, MD: Well, again, I might take a little bit of a windy course to answer that, mostly because I don't want to focus so much on these very rare events. I mean, I think that this is what my job's all about, so I think about it a lot. But the most common issue for kids, especially in recent decades, is obesity. And early onset related issues like hypertension, diabetes, high cholesterol.

And these conditions are not good for the heart in the longterm. They can lead to coronary artery disease and heart failure in adulthood and even early adulthood if it's extreme. So while exercise and sports participation is a great way to combat that, and it's really key, I think, to maintaining a healthy weight in childhood; I don't want to gloss over the importance of kind of other healthy behaviors like healthy nutrition. But, to answer your question a little more directly, the more rare causes for cardiac events in otherwise healthy appearing athletes are issues that I as a pediatric cardiologist and the rest of my team take care of. Things like hypertrophic cardiomyopathy, abnormal coronary arteries, or inherited arrhythmias.

Host: Okay. And it makes me wonder, Doctor, how different sports, you know, come into play, right? That sometimes we're talking about sort of what's expected of athletes in the different sports, the level of exertion, if you will.

But also what's involved, you know, the sort of traumatic impact, you know, to the chest at just the wrong time with certain sports, like hockey, for example. Just wondering, do we need to consider the sports as well when we consider heart health in young athletes?

Katherine Hansen, MD: This is a super interesting question as a cardiologist because I love cardiac physiology. I'm an exercise cardiologist. So I spend a lot of time kind of with exercise testing and thinking about how exercise testing informs how the heart and the lungs and the muscles and the brain all work together to exercise.

So we do know that actually different types of exercise have a very different effect on the heart in terms of how it can even remodel or kind of grow in certain ways, I guess you could say. So things like aerobic exercise is really one of the important ways to kind of train your heart. 

I always tell patients, just like a bicep, if going to do bicep curls, your bicep will get stronger. And so things like aerobic exercise are really important to, you know, make your heart as strong as possible and help it function effectively. And other types of exercises have maybe different loads on the heart, things like, you know, power lifting can have a different effect on the heart.

As the cardiologist, I think about this a lot in terms of when I look at a child's echocardiogram or an elite athlete's echocardiogram or ultrasound of the heart. The heart can actually remodel in certain ways, especially for folks who are spending many hours a day in their sport or activity.

 Interesting question for me, but I think maybe less so for the general population. But yeah, the answer is yes different types of exercises certainly have a different effect on the heart.

Host: You talked earlier about some of the warning signs, fainting, for example. So I wanted to go back over that. Just the warning signs that maybe parents, coaches, trainers, whomever should be on the lookout for. And then what do we do if we're worried? I assume speak up would be a good thing, but from you, what should we do?

Katherine Hansen, MD: I think of exercise as the way to stress the heart, which is why exercise testing has such a valuable utility in our clinical care of patients. When you're stressing the heart, if the heart doesn't tolerate that stress well, then exercise is really the time where you might see some symptoms come up.

So things like chest pain when you're exercising, near fainting or fainting. Those are certainly things to talk to your doctor about or even to seek medical care immediately for. And I think the other things to consider discussing are if your child has a change in kind of what they typically can do.

Of course, if you have an acute, um, you know, a virus or something going on that can kind of take you out of commission for a little bit. But, in general, if you feel, if your child's not able to keep up with other kids or, there's been a change over time, I think that's not necessarily the heart, but certainly something to talk about.

 And I think a lot of these issues, even chest pain, abnormal shortness of breath with exercise, fainting or near fainting, honestly, even those are very rarely because of a heart problem in children, but it's something that we want to rule out and make sure is not the case. So yeah, I'd say chest pain, fainting, feeling abnormal kind of palpitations or heart racing. Those are all things to get checked out.

Host: And I wanted to ask you, you mentioned, sports physicals, you know, seeing your doctors before whatever sport is going to be in season. I want to ask about the use of EKGs in those sports physicals, because it seems to me, this is anecdotal at best, Doctor, but it seems to me that sometimes they do that, sometimes they don't.

 Maybe we can request it and we don't know we can request it. Just wondering your thoughts, especially with your, you know, specialty and interests, your thoughts about EKGs in those sports physicals. In other words, to find the undiagnosed, the un sort of recognized heart issues.

Katherine Hansen, MD: We always think about the pros and cons of screening modalities. You know, it's important to catch these rare conditions, but it's also important not to overly cause stress if there's a positive result that actually ends up being negative. And, you know, there's implications in terms of doing large scale screening in terms of cost. So we do try to think about all of those things.

Host: Yeah, that's perfect. How about preventative methods for maintaining heart health? Like, we know they're already athletic, right? And they're participating in sports. And as you said earlier, you know, some sports are more demanding than others. But are there things that we can do or things that we can encourage our kiddos to do?

Katherine Hansen, MD: As a cardiologist, it's really all about regular exercise. And I think the downside to having this kind of ready to go structure around exercise is that maybe kids and families don't learn how to self-initiate it when they don't have that available. So if a child is playing a sport, they're used to that, but then they stop playing that sport.

You know, what you really want is to help them learn how to self-initiate that physical activity exercise so that as they grow and as they're learning, they learn to incorporate that into as something essential for them to do. Really the bottom line is to like try to get to that, you know, hour a day of activity.

It doesn't have to be all at once. It can be choosing to take the stairs instead of the elevator and adding up those minutes. I think all of those little decisions that we make throughout our day can be important and impactful in our health. Sports is just such a great way to, make sure kids are kind of getting that experience and there's just so many other benefits to it as well.

But even if they're not in structured sports, you know, extra important, I think, that we help support them to figure out healthy routines that they can carry forward in their life.

Host: Yeah, healthy eating, getting some exercise. With my kid, it's more about trying to like hold her back, you know, from pushing herself too hard, even when she's out of season, you know, she'd be like, I'm going to go for a run. I'm like, yes, sure. But you don't have to, you know, like, yeah.

Katherine Hansen, MD: Yeah, there's there's such an important role to rest in all of this. And I really think of exercise as a medication. And when it's helpful to think of it that way, I think it can be very illustrative. So just like a medication you can underdose and you can overdose. And just like a medication thinking about how many times a day you're doing it, how long you're doing it, the different types that you're doing it.

There's kind of a whole process or framework that we think about that. But I totally agree. I generally take care of the kids who maybe aren't exercising enough, but, I think on the other side of the spectrum, and that was probably me, honestly, when I was in high school, you know, the, on the other side of that, there's the ones who are overdoing it and maybe don't recognize the value of appropriate rest.

 I've certainly seen kids whose performance starts to decline because they're just working so hard, you know, and I think, part of that counseling is helping them recognize the importance of recovery.

Host: Right. Good stuff today, Doctor. Ah, brought a smile to my face and any other advice you have for families as we try to support young athletes and maintain that good heart health?

Katherine Hansen, MD: You know, I think especially in competitive sports, it can be tough to keep our eye on the whole purpose, right? And, our program that we do for exercise training for children with congenital heart disease, it's really modeled after adult cardiac rehab.

It's all about exercise, like aerobic, strength, flexibility type of exercises, but we recognize that really what this is all about is making sure that exercise is fun so that they want to do in the long term and recognizing that exercise gives you so many different opportunities to build mental skills, life skills.

And so I just want to, you know, remind us all that especially competitive athletics, it's really all about those skills for life and the opportunity that those sports can provide to really build those skills.

Host: Yeah and for friendships for life. Some of my best friends are those guys that I met on the first day of football practice in high school. You know, when we were 14 years old, like I can still remember meeting those guys. And we're still friends to this day. So as you say, it's more than just about the exercise and the athleticism when it comes to sports. It's good for the mind, the body, the soul, all that good stuff. So, thank you so much for your time today.

Katherine Hansen, MD: Oh, I so agree. Well, thank you very much, Scott. Nice to talk to you.

Host: That's Dr. Katherine Hansen,

Scott Webb (Host): Pediatric Cardiologist and Director of the Exercise and Sports Cardiology program at Children's Health.

Host: And for more information, go to childrens.com/exercisecardiology. 

 I'm Scott Webb. And thank you for listening to Children's Health Checkup. If you found this podcast helpful, please rate and review or share this episode, and please follow Children's Health on your social channels.