Sometimes, timing is everything. Such was the situation for the University of Tennessee men's athletic department when a gift of free echocardiograms for every student-athlete helped identify two potentially serious heart conditions that would have likely otherwise gone unnoticed.

One case involved Duke Crews, a forward for the men's basketball team, who was placed on complete rest after an abnormality was found during his echocardiogram. The second was a walk-on football player who had surgery to remove a growth that was noted during his test.

"It's hard to predict what the future would have held if we hadn't intervened," says Head Team Physician Chris Klenck. "But we were certainly fortunate to have caught both of these problems at an early stage and be able to correct them."

Klenck says the sports medicine staff had been discussing the idea of adding echocardiograms--ultrasounds that examine the physical workings of the heart--to their preparticipation physical examinations (PPE), but were concerned about the cost-to-benefit ratio since several hundred dollars are needed to cover one screen. Previously, the department had only done such tests when an athlete's medical history or a standard heart check during the PPE indicated possible problems.

Currently there is much debate about the topic of routine heart screenings for athletes. Electrocardiograms (EKGs), a similar test that looks at the electrical functioning of the heart and costs about $100, are common for athletes in Europe. Those with abnormal results are often given echocardiograms to further identify the problem. An Italian study published in 2006 found that deaths from sudden cardiac arrest in athletes dropped by 90 percent after screening EKGs were made routine in 1982.

The American Heart Association does not currently recommend routine EKGs or echocardiograms, explaining that the number of deaths that typically occur due to heart abnormalities is very small, while the cost of such screenings is high. Instead, it suggests that PPEs ask athletes about any family history of heart problems and use physical exams to look for signs or symptoms of heart disease.

"If you look at the literature, nothing recommends that EKGs or screening echos are cost efficient and that's probably true," Klenck says. "You don't find a lot of positive results just by screening everybody."

At Stanford University, all 800 student-athletes were offered a free EKG last fall as part of a study to determine whether the cost of routine EKG screenings is justified. Only one of those student-athletes was found to have a condition that required medical attention. The researchers plan to add echocardiograms to their screening tests next year, and full results from their study are expected in two to three years.

In the Volunteers' case, Mickey King, President and CEO of Digirad Ultrascan Solutions in Atlanta--a Tennessee native and self-described UT nut--took cost out of the equation by donating the equipment and services needed to screen all 500 athletes. "This donor stepped forward and said, 'This is my business, and I would be more than happy to donate these services because I think it's well worth it,'" says Klenck.

Technicians came to the campus about every four weeks and tested 50 to 100 athletes each visit. Thus it wasn't until December that Crews received his echocardiogram. "There was a concern noted on his screening echo, so we did some follow up-tests and removed him from competition," says Klenck, who couldn't go into detail on Crews's condition due to privacy laws.

"We involved a lot of cardiologists from across the country who specialize in athletes' cardiac issues," Klenck says. "Duke had a great response from just resting and monitoring and was able to return to the lineup six weeks later."

Now that of all the department's athletes have had screening echos, Klenck says they will only need to test the 100 or so new participants that come into the program each year. "We won't screen returning athletes every year," Klenck says, "unless there is something that indicates a need to follow up on a yearly basis."

For a more in-depth look at the issue of routine heart screenings for athletes from our sister publication, Training & Conditioning, go to www.Training-Conditioning.com and type "Following Their Hearts" into the search window.