Effective Cardiovascular Screening of Military Recruits Requires an Electrocardiogram

Murphy, Caroline; Saperstein, Adam K.; Klusewitz, Seth; Bartol, Kyle D.; Aun, Jonathan A.; Wessman, Dylan; Arnold, Thomas; Symons, John Gideon; Goldstein, Robert E.; Needleman, Matthew; Franzos, M. Alaric; Haigney, Mark C.

doi:10.1016/s0735-1097(22)02629-8

Cited by 4 publications

(4 citation statements)

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“…After 3 preventable sudden cardiac arrests at the US Naval Academy in 2020, a demonstration project reintroducing ECG screening showed it to be an efficient and effective process, taking 9 minutes per individual screened with a false-positive rate of less than 2%. Screening of nearly 4100 midshipmen uncovered significant issues in 0.5%, as well as 3 cardiac conditions with a high risk of SCD, conditions that are not compatible with continued military service 29 . Based on those results, the 2021 National Defense Authorization Act, Section 733, directed the remaining service academies to perform ECG screening on at least 25% of the incoming class.…”

Section: Discussionmentioning

confidence: 99%

“…Screening of nearly 4100 midshipmen uncovered significant issues in 0.5%, as well as 3 cardiac conditions with a high risk of SCD, conditions that are not compatible with continued military service. 29 Based on those results, the 2021 National Defense Authorization Act, Section 733, directed the remaining service academies to perform ECG screening on at least 25% of the incoming class. Italy mandated ECG screening for athletes in 1982 with a dramatic drop in SCD after implementation.…”

Section: Cardiac Screening In the Military Settingmentioning

confidence: 99%

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Exertional-Related Sudden Cardiac Death in a Young, Presumed Healthy, and Medically Screened Population

McLeod

Walsh²,

Haigney³

et al. 2023

Am J Forensic Med Pathol

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Sudden cardiac death (SCD) is defined as death from cardiac causes with loss of consciousness occurring within 1 hour of a change in cardiovascular status. As subset, SCD associated with physical exertion (SCD/E) can be defined as a cardiac event whose symptoms start during or within 1 hour of physical exertion. The US military represents a unique opportunity for studying SCD/E because of medical screening at recruitment, mandatory physical training, an active surveillance system, and centralized autopsy services. Because of medical screening, recruits are presumed healthy, but significant conditions can go undetected. We present 4 diverse cases of SCD/E in the military setting. Sudden cardiac death associated with physical exertion is often the first indication of a serious occult cardiac pathology. Postmortem genetic testing revealed a causative pathogenic mutation in 1 of 4 cases, enabling genetic testing of family members to prevent similar catastrophic loss of life, underscoring the importance of postmortem evaluation including genetic testing. Further investigations will help direct screening and prevention to capture those at risk for SCD. The cases presented in this series are a sample of the diverse etiologies and contexts surrounding SCD/E in the military setting that have been captured by Armed Forces Medical Examiner System.

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Section: Discussionmentioning

confidence: 99%

Section: Cardiac Screening In the Military Settingmentioning

confidence: 99%

Exertional-Related Sudden Cardiac Death in a Young, Presumed Healthy, and Medically Screened Population

McLeod

Walsh²,

Haigney³

et al. 2023

Am J Forensic Med Pathol

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“…Naval Academy midshipmen, 16 of 19 cardiac abnormalities with potential sudden cardiac death (SCD) vulnerability were identified with electrocardiogram screening in addition to the standard American Heart Association–recommended approach (questionnaire and physical examination) to cardiovascular screening. 2 We propose that a screening electrocardiogram would have identified this patient’s LQTS diagnosis and potentially led to exercise restrictions and occupational career guidance changes.…”

Section: Discussionmentioning

confidence: 99%

Congenital Long QT Syndrome and Cardiac Arrest in a Military Tactical Athlete

Chung,

Keithler,

Smith

et al. 2023

JACC: Case Reports

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“…Guettler et al detected it in only one patient among a 300-man German aircrew [ 16 ]. Murphy et al diagnosed Wolff-Parkinson-White syndrome (WPW) in seven and Brugada syndrome in one of the recruits [ 17 ]. In the American army, 386 paroxysmal atrial fibrillation (AF) emerged in 15 years of follow-up, 40% of which were deployed [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Military Recruits With Complaints of Palpitations After Physical Training: A Study From Turkey

Günlü¹,

Aktan²

2022

Cureus

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Recruits undergo medical examination before mandatory service. After enlistment, if recruits have health problems, they are sent to a medical board to establish fitness for their duties. We aimed to analyze the complaints of palpitations after physical training in recruits without a known history of cardiovascular disease (CVD) and determine whether the diagnoses were suitable for duty. MethodsThis cross-sectional descriptive study was conducted among 25,666 participants who were admitted to an outpatient cardiology clinic due to complaints of palpitations between August 2016 and June 2022. Information regarding socio-demographic characteristics was collected. Laboratory test results and electrocardiography (ECG) were analyzed. The diagnoses were evaluated. ResultsIn total, 582 patients who were dismissed from the military were included in the study. The mean age of patients was 19.23±2.02 years. Among the patients, drug use (26; 6.2%) and history of addictive substance use (178; 30.6%) were low. The number of days of service under 10 was high (450; 77.3%). The prevalence of sleep disturbance (122; 21%) and hydration habits (154; 26.5%) were low. According to ECG findings, premature atrial contractions were high (250; 42.9%). There was a significant correlation between the ECG findings and seasons (p<0.001). Rheumatic valve disease (83; 14.26%) and supraventricular tachycardia (77; 13.23%) were the most common diagnoses. Conclusion2.2 percent of all participants admitted to the hospital due to palpitations were dismissed from the military service, and 0.7 percent of them were diagnosed with cardiac conduction system disease.

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Effective Cardiovascular Screening of Military Recruits Requires an Electrocardiogram

Cited by 4 publications

References 0 publications

Exertional-Related Sudden Cardiac Death in a Young, Presumed Healthy, and Medically Screened Population

Exertional-Related Sudden Cardiac Death in a Young, Presumed Healthy, and Medically Screened Population

Congenital Long QT Syndrome and Cardiac Arrest in a Military Tactical Athlete

Evaluation of Military Recruits With Complaints of Palpitations After Physical Training: A Study From Turkey

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