Maggie McKay (Host): Welcome to the Peds Pod by Lab Bonner Children's Hospital. I'm your host, Maggie McKay. Today we're talking with Ranjit Philip, associate Chief of Cardiology and director of the Pediatric Cardiology Clinic at Lab Bonner Children's Hospital. Thank you so much for being here today. So doctor, what is sports cardiology?

Dr Ranjit Philip: So, You know, sports cardiology is a specialty focused on keeping young athletes safe while helping them perform at their best. the way I think about it is, You know, we evaluate how the heart responds to exercise, identify any cardiac conditions, and help athletes, families and coaches make informed. Evidence based decisions about, safe participation in sports.

You know, our goal is not to limit kids, but really to keep them active in the safest possible way, sort of a prescription for exercise.

Maggie McKay (Host): I've never heard of that term. That's so interesting. Who is part of the sports cardiology team at Lab Bonner?

Dr Ranjit Philip: we like to call it a real multidisciplinary approach, And so truly what we have is a group of us, pediatric cardiologists who are, dedicated expertise in sports and exercise physiology. We do lay hands with some of our advanced imaging specialists, looking at other structural, problems with the heart as well as.

really our partners in electrophysiology, which looks at the electrical activity of the heart, and even genetics at times in certain patient's. And so it is a real multidisciplinary team, which has a sort of pediatric and a, collegiate. Part to it. We have, Ryan Stevens, who leads our, sports cardiology for the, collegiate athletes and high school athletes, and is really on a, speed dial with a lot of our athletic trainers in the community.

And so I would say our athletic trainers and nurses in schools are also really part of, really a true sports cardiology team because our goals are the same. Make sure every kid can play and play safely.

Maggie McKay (Host): What drew you to work in sports Cardiology.

Dr Ranjit Philip: You know, I've always loved this intersection between the science of the heart and, really the culture of sports, right? Athletics, sports is such a meaningful part of childhood and adolescence. You know, it really shapes identity, confidence, friendships, and it may mean scholarships for a lot of kids. But with that comes responsibility.

And when a collapses or makes the news on television, what's our responsibility is understanding how terrified these families are. Understanding the importance of health screening, to be able to step in, give clear answers, and guide an athlete safely back into the field. that's a really incredibly meaningful experience to have.

the easy thing is to say, no, you can't exercise. Right? But. navigating this journey with the child or with the athlete and their family, their athletic trainer. that's the part that really what draws folks like me, to this And what we're really passionate about is getting them back on the field, because the buck stops at us, Our goal is to make sure they can do it safely, And also do it with a free mind and giving them that passport to exercise, means a lot, to them.

Especially a lot of folks who are actually on scholarships in a lot of our universities here in town, they wanna get back in on the field, you know, and how fast we can help them achieve That is where we come in. And why we're different from, say, just generally going, to your, pediatrician.

we help transfer that liability from the pediatrician onto us to help make that decision for them.

Maggie McKay (Host): And how does a child end up in your clinic? What do clinic visits look like?

Dr Ranjit Philip: we have a two-pronged referral system, so you either get a referral directly from pediatricians in the community, or we now on the collegiate side, we'll get them from athletic trainers and sports medicine physicians. Like, we have sports medicine physicians who are usually family medicine trained or. Orthopedic trained who will, refer patient's to us.

We also get patient's directly, they can go to our website and just a family member who just got to know that they have some kind of family history of a concerning diagnosis. A lot of times they will just reach out to us directly saying, Hey, we have this family member, who passed out on the field.

We wanna make sure that the other family members are okay. So that's another avenue through which Patient's come to our clinic And what are we doing for them? Well, I think really taking a good detailed history, you know, the art of That is sometimes lost, but focusing on symptoms during exercise, doing a full physical exam, And in most occasions, getting something called an EKG, which looks at the electrical activity of the heart.

Looking at the structure of the heart with an echocardiogram, are things that we would do in the clinic. And from that point we would see, hey, does this patient need advanced testing, such as needing our exercise lab? So where we would make them run on the treadmill and evaluate their electrical activity of the heart, ev evaluate their blood pressure with exercise and see how fit they are.

You know, we could go to that level and do more advanced imaging, like something called a cardiac MRI, which gives a better view of the structure of the heart and better understanding of. Scar on the heart, in terms of risk, profiling for patient's?

Maggie McKay (Host): Who do you recommend see a cardiologist before they participate in sports?

Dr Ranjit Philip: not every patient needs to see a sports cardiologist. Obviously we are happy to see anyone and anyone that seeks our care, but symptoms during exercise. Kids with symptoms during exercise And what are those symptoms? Chest pain. Or passing out with exercise, inactive exercise. I'm not talking about the person that stands up from a sitting position and passes out, right?

many of us may have had that situation or felt dizzy wh when we stood up suddenly from a sitting position. We're talking about exercise related symptoms of chest pain. Palpitations That is heart racing and dizziness and fainting. Anyone with a family history of sudden cardiac death, young person who suddenly died, that warrants.

Evaluation by us. during the COVID Ovid 19 era, when we had the pandemic, that's a time we saw a lot of kids with that and with something called inflammation of the heart called myocarditis, who when they were returning to high intensity sport we would have to see them to make sure that they were.

To, to high intensity sport or how to get to high intensity sport after an illness like that. So that, And then of course, the bread And what we do is p. Kids with congenital heart disease. for years we've told kids with congenital heart disease that, oh no, you gotta be careful.

Don't exercise. The easiest answer was, don't exercise, nothing bad will happen to you. And then now we've seen the after effects of that, right? Like we've gone through generations where we've told them don't exercise, and now they're not fit and they're, not healthy. And then you have the old age problems of, not exercising, So, these are the four main categories that we look at, is for who should seek our care.

But, if there's ever a doubt, we prefer to take a closer look rather than miss something imported. that's what we tell our pediatricians in town. That's what we tell the athletic trainers in town,

Maggie McKay (Host): Right. It sounds very thorough, which is always good, better, safe than sorry. Right. so you touch on this a little bit, but what tests might a child have if they are being seen for sports cardiology?

Dr Ranjit Philip: we do three basic tests, like we said. So one is the EKG, so the electrocardiogram looking at the electrical activity. Then we do an echocardiogram. Or what's called an ultrasound of the heart to look at the structure of the heart, because the two commonest causes of sudden cardiac death are having a thick heart, which is called hypertrophic cardiomyopathy.

The second is, having anomalous coronary artery. So, the arteries which supply your heart if they come out abnormally. So Those are the two main things, and you can get that information by a standard echocardiogram or heart ultrasound. Now, then we go more to Tailored Care where we are like, Hey, based on what's going on, we might do an exercise stress test or a cardiopulmonary stress test at our exercise lab at the Heart Institute here at Labon.

Or we would put something called a Holter monitor, which would record EKG over a prolonged period of time. So. Akin to sort of being in a hospital, but not, right? Yeah. So you, go home, do your daily activities, And we have a monitor connected to you, seven days, 14 days, 21 days.

And we can monitor your heart rhythm, with that. And then of course, advanced imaging, like something called a cardiac MRI, which gives you better resolution of the heart muscle and things like that. And usually we go to that kind of testing. If we have doubts in our first panel of tests, which is our EKG and echocardiogram.

Maggie McKay (Host): Dr. Philip, what signs should parents watch out for in their young athletes, and when should you talk to your pediatrician?

Dr Ranjit Philip: So I tell parents to pay attention to any symptoms that happen during or immediately after exercise. Now, what are those symptoms? Number one, chest pain. Number two, fainting or near fainting with exercise number three, palpitations or racing of your heartbeat. And just generalized extreme fatigue compared to peers that's not related to like an infection or fever or something else that's going on.

Yeah. Those are the main things we look at. And, really symptoms with exercise would be, or sort of key word, that, is something we look at because history is very important and pediatricians and family members, if there is a family history of sudden cardiac death or inherited heart disease, screening is very important in those patient's.

And so that's another key thing. We're not talking about someone who had a heart attack at 50. We're talking about a family member in their twenties on the football field. passed out and didn't make it. But that's the kind of patient that we want their family members to be, tested because those things run in families.

That is the hypertrophic cardiomyopathy or the thick heart. And Those are the type of patient's we would wanna see.

Maggie McKay (Host): And earlier on you mentioned college age athletes. Does Le Bonner see college age athletes for sports cardiology?

Dr Ranjit Philip: Yes. In fact, That is, really the genesis of our sports cardiology came from that. So, the way it works is like, so, say, in town you have a University of Memphis, you have Rhodes College, you Christian brothers, And then of course at the next level is like. You would say like our NBA team, the grizzlies.

Right. So all of these teams have sports medicine physicians with them. they usually go to those physicians. and. When they see something, if it is something related to the heart, they call us. And so usually it's either those physicians or the athletic trainers who are seeing them in practice.

So they have, in our case, we have Orion Stevens who runs that for us. with the collegiate themes and he's literally on speed dial. And we'll see them within 48 hours in clinic and get all this testing done for them because. for lack of a better word, say like That is the neediest group because they have a game on Sunday and they're calling you on Monday.

They wanna make sure that this player can actually participate, because of a scare of some sort that has happened, during training, right? And so we service. all the colleges in town. and a lot of times what usually happens is, the athletic trainers talk to each other. And so then now we have a lot of our high school athletic trainers calling us to want.

A direct quick evaluation, an expedited evaluation of these patient's or kids and, college athletes, to be precise and, because as you know, what usually will happen if you go. To the primary care provider, they will then refer them to us. And then now between that time and getting the next appointment, there's a big gap.

And a lot of times that affects a lot of these, teams where, they're having games almost every week or multiple times in the week where, they wanna be seen in an sort of expedited manner. so what we are doing is. And that cohort is giving clearance guidance for return to play.

key word of return to play after, COVID was a big thing. same way as return to play after any sort of event that happens to you. And we're able to provide that information and really scan and screen who needs more further testing.

Maggie McKay (Host): And so in closing, what happens if you do find a heart condition in an athlete?

Dr Ranjit Philip: that's a very hard, thing, especially for a competitive collegiate athlete or high school athlete, right? 'cause the high school athlete is, maybe being drafted, maybe being, looked at by, recruiters. and why I say that's a very difficult group is you don't get much from the athlete, the athlete. Wants to say that everything is just fine and okay, because he knows the impact it's gonna have if he.

Cannot play or is restricted from playing. So the first thing we do is slow down and explain everything clearly and upfront. We sort of tell them like, Hey, we are not here to tell you not to play. We are here to navigate this with you, so that you can play and get back to playing sooner than later.

not all hard findings mean that a child has to stop. Playing sport. Sport. And so we kind of make that very clear. Once we do that, we determine the diagnosis and how that diagnosis impacts sports participation. And all of This is with evidence-based guidelines. And then we sort of create this personalized management plan.

there is some conditions in which you may have to wait a couple of weeks to get. Advanced imaging. especially if you had an infection or something, you know, a lot of these things could be transient and things can look bad in the moment. But time sometimes plays a role.

And so we, discuss those things with these, athletic trainers, coaches, and with the athlete themselves and get them on the same page to now make this sort of personalized management plan to get them back to sports sooner than later. And it involve. the test that I just talked about, right?

The EKG echo, sometimes an MRI, sometimes a stress test, to get that because our philosophy is always protect the athlete, preserve their identity and help them stay active whenever it is safe to do so. That's really what we wanna do. so once the stigma and fear of seeing a doctor goes away, cause that's what they associate us with, Hey, that's the person that's gonna.

Restrict my career or limit my career, right. So once we've crossed that barrier, then I think everything is much easier.

Maggie McKay (Host): Well, thank you so much for sharing your expertise today. This has been fascinating. I did not know anything about sports cardiology, and now I do, so thank you for your time.

Dr Ranjit Philip: You're welcome. You're welcome. I'm glad, you learned something from this as well. And, I hope other's who listen to this, do as well. And again, we're always available, no question is a wrong question,

Maggie McKay (Host): That's great. Again, that's Dr. Ranjit Philip. And if you'd like to find out more about Lab Bonner's Heart Institute And the sports Cardiology clinic, visit lab bonner.org/heart. I'm Maggie McKay. Thank you for listening to the Peds Pod by Lab Bonner Children's Hospital.