Consultation with the Specialist: Cardiovascular Preparticipation Sports Screening

Anoop Singh, MD* 2. Michael Silberbach, MD† 1. *Fellow, Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, Ore 2. †Editorial Board After reading this article, readers should be able to: 1. Describe the key cardiac elements of the preparticipation examination. 2. Identify red flags in a patient’s cardiac history and physical examination that warrant consultation with a cardiologist. 3. Characterize the cardiovascular findings of the well-trained athlete. 4. Recognize the common causes of sudden cardiac death on the playing field. 5. Discuss the absolute and relative contraindications to athletic participation. In the United States, the preparticipation examination (PPE) has become a standard for athletic clearance of high school students in nearly every state. This screening serves many purposes, but a primary goal is to restrict athletic participation of those who may be predisposed to dying on the playing field. The death of a high school athlete devastates the child’s family, significantly affects the local community, and often generates extensive media coverage. Fortunately, sudden death remains a rare phenomenon; best estimates predict an incidence of 1 per 200,000 high school athlete-years. In 75% of such cases, cardiovascular disease is the cause. Accordingly, medical professionals must have a keen sense for detecting silent cardiac disease in young athletes. The medical history is the most important part of the cardiovascular PPE. It is best to ask open-ended questions of the patient. A volunteered complaint warrants greater attention than a “yes/no” response. A checklist of questions that probes for potential cardiac disease is also helpful (see the form available in the online version of this article only). Family concerns or observations complement the picture of the adolescent’s health. Indeed, the American Heart Association recommends that a parent verify all elements of the history. The personal history focuses on symptoms such as chest pain, chest tightness, dyspnea, near-syncope, syncope, dizziness, exercise intolerance, and fatigue. The setting in which symptoms occur is very important. Symptoms in the context of athletic activity may …