Annual preparticipation cardiovascular screening of athletes is a generally accepted practice.1,2,3 The main objective of the screening is to identify risk factors that predispose a previously asymptomatic and apparently healthy athlete to sudden cardiac arrest and death.
History is the most important aspect of cardiovascular screening of young athletes. The history has been shown to have the most yield for identifying potential risk factors for adverse cardiac outcome. The key elements of cardiovascular screening history are summarized in Table 14-1.14
Table 14-1. Cardiovascular Screening History |Favorite Table|Download (.pdf)
Table 14-1. Cardiovascular Screening History
Exercise-related chest pain
Presyncope or syncope during exercise
Heart racing or skipping beats during exercise
Exercise-related shortness of breath
Recent febrile illness
Congenital heart disease
Known heart murmur
Known high cholesterol or lipid disorder
Any diagnosed heart disease
Any previous or currently recommended physical activity restrictions
Current use of therapeutic medications, dietary supplements, over-the-counter medications
Current or past history of substance abuse, smoking, or other forms of tobacco use
Death of close family relatives before age 50 y from a cardiac or unknown cause
Congenital heart disease including Marfan syndrome, cardiomyopathy, long-QT syndrome
A general physical examination may reveal some important clues to cardiovascular disease, exemplified by the wide ranging clinical features seen in Marfan syndrome (Table 14-2).5 Key elements of cardiovascular examination are summarized in Table 14-3. Heart murmurs are a common finding in children and adolescents and it is important to appropriately distinguish the benign from pathologic murmurs that will indicate need for further evaluation. A simple classification of heart murmurs is presented in Table 14-4, the effects of certain physiologic maneuvers on cardiac auscultatory events are summarized in Table 14-5, and clinical clues that help identify benign heart murmurs are summarized in Table 14-6.4,6
Table 14-2. Criteria for Marfan Syndrome |Favorite Table|Download (.pdf)
Table 14-2. Criteria for Marfan Syndrome
Requirements for System Involvement
Medial displacement of the medial malleolus causing pes planus
Facial appearance (dolichocephaly, down- slanting palpebral fissures, enophthalmos, malar hypoplasia, retrognathia)
2 major or 1 major plus 1 minor criteria
High-arched palate with crowding teeth
Pectus excavatum requiring surgery
Protrusio acetabulae of any degree (ascertained on radiographs)
Pectus excavatum of moderate severity
Reduced extension of the elbow
Reduced upper-to-lower segment ratio or arm-span-to-height ratio >1.05
Wrist and thumb sign
Note: 4 of 8 major criteria for the skeletal system are required to confirm the diagnosis of Marfan syndrome.
Abnormally flat cornea (as measured ...
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