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P E A K | W I N T E R 2 0 1 5 to heart disease, whether a close relative under the age of 50 had disability from heart disease, and whether there had been prior recognition of a heart murmur. The focused physical exam section included checking the bilateral femoral pulses and the brachial artery blood pressure in both arms while the student-athlete was seated. "We've had those questions incorporated for years," explained Turco of the old protocol. "That would be evaluated through our office. Anything that was answered yes would come to my desk and then we would make a decision whether we should do more. "In the past, you only had an EKG if you had an abnormality in your questions. And I would say with young, healthy people like this, probably only one in 20 would need to get an EKG." The implementation of the new cardiac protocol that includes an on campus physical exam as well as the EKG traces back to a talk given at the Ivy League sports medicine meeting by Dr. Aaron Baggish, the associate director for the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center who was having all Harvard athletes undergo EKGs in his role as the university's team physician and cardiologist. What Turco and Beaver heard when they met with Baggish in Boston led them to suggest Dartmouth consider the new cardiac protocol both for the safety of Big Green athletes as well as to contribute data to the study of sudden death in athletes. Although issues like those that affected Tucker and Steinberg might be undetectable and the incidence of any significant abnormality would be slight, "There are some things you definitely can pick up," Turco said. "And the more numbers you get the better. We said that maybe we can team up with Harvard, and if Princeton does it, pool all of the data." "Everybody at the college has gone into this with the right attitude," said Beaver. "It is, we are trying to make sure everyone is safe and also contribute to the greater good overall. It is a way to help shape the future. "Jack and I, the trainers and everyone involved has spent a lot of time having meetings and talking about this and how we are going to do it." This year's freshmen underwent EKG testing at Dick's House during several sessions in late August and early September. In addition to the EKG, the 12 cardiac-related areas that have historically been addressed by the home medical provider were checked locally. Those athletes with an abnormal EKG quickly underwent an on-site echocardiogram. "There are some well-known abnormalities that you can pick up on echo like hypertrophic obstructive cardiomyopathy," Turco explained. "That's what a lot of people can die suddenly from, and you can pick it up on echo." Beaver was at Dick's House helping oversee the testing and reading the results in real time. "We had portable echocardiogram in one of the rooms here," Turco said in his Dick's House office. "So the two or three people that needed them got them that same night." That offered two real benefits. One was that the student-athletes could be cleared right away to return to practice. "The other thing is when you tell someone you have an abnormal EKG they are anxious and their family is anxious," Turco explained. "We wanted to be appreciative of that and try to get things done quickly." The echocardiogram and its on-site reading gave all of the tested athletes the OK to return to action. "We haven't picked up anything that would prevent someone from playing," said Turco. "It certainly is possible that we could have found an abnormality that would have, but those, fortunately, are few and far between." Even if there had been findings that were borderline concerning it wouldn't necessarily have meant the end of an athlete's career. "What Dartmouth is about is an informed participation," Beaver said. "So if you find something, it doesn't necessarily always exclude someone from participating, but it will help the athlete and their family understand what the consequences and the risks are of participating, even if it is not a high risk." Having an expert like Beaver who knows how to read an athlete's echo – which can appear abnormal to the someone unfamiliar with an athlete's heart – reduced the 26 100% OF VARSITY ATHLETES COMPLETED 12-POINT EXAM AND EKG

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