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“We’re lucky. We have lots of young medical students and residents,” said Dr. Euan Ashley, director of the Stanford Hospital HCM Center. “The argument is always financial.”

An EKG costs about $50, but an echocardiogram costs upward of $1,000. Some of the equipment is costly, as is finding the right people to interpret the results.

“Doing an EKG is not hard,” said Lisa Salberg, founder and chief executive officer of the Hypertrophic Cardiomyopathy Association. “Reading what’s on the paper is harder than what most people think. The nuances are so subtle, the line between normal and abnormal really needs to be evaluated by a really skilled eye.”

Salberg said HCM often is misdiagnosed as something else, usually asthma, a heart murmur or panic or anxiety attacks.

“We need to look at these kids more closely,” she said.

But right now it’s not cost-effective. Still, Abraham said any athlete diagnosed with HCM or another abnormality Saturday can receive follow-up treatment regardless of their financial or insurance situation.

In Maryland, as most states, athletes are given the “standard recommended physical,” said Ned Sparks, director of the state public high school athletic association. Sparks said a conglomerate of several associations, including the American Medical Society for Sports Medicine and the American Academy of Pediatrics, recommend the physical.

For the last two years, Maryland and other states have used a list of questions recommended by the American Heart Association as part of their preparticipation physical exams for high school athletes. Some of the questions deal with family history and are designed to identify possible high risks for heart abnormalities.

Those questions, along with a new test for Marfan’s syndrome (another cause of sudden death) and more advanced cardiovascular testing, “have all done a pretty good job,” said Dr. Vito Perriello, chairman of the sports medicine advisory committee of the National Federation of State High School Associations.

“All of those are major improvements,” Perriello said. “But there are still a number of sudden deaths in athletes every year, and a number of those end up being undetected, unknown cardiac abnormalities. … There are still youngsters that, had they had the EKG and the echo, it still would not have been identified.”

No test is foolproof or 100 percent definitive. And just because a test reveals nothing one year doesn’t mean something might not occur later on.

“It’s not a guarantee forever,” Salberg said of even the most advanced testing. “It’s a moment in time.”

Perriello still recognizes the value of using advanced equipment.

“That’s where over the last 20 years, the argument or the debate or the judgment call is,” he said. “Is it practical? Is it possible? … Every time there’s a tragedy, this comes up. But even if we did an EKG or an echo on every individual playing sports, we would still not identify every single cardiac death that has occurred in athletic competition.”