All major groups acknowledge that EKG screening improves the sensitivity of the preparticipation physical exam. The European Society of Cardiology Study Group of Sport Cardiology and the International Olympic Committee advocate routine screening.6,7
The American Heart Association (AHA) Council on Nutrition, Physical Activity, and Metabolism and the American College of Sports Medicine don’t recommend routine EKGs as part of the preparticipation evaluation of school-aged athletes.8,9
The AHA recommends that a qualified examiner perform a full history and physical exam, which includes assessments of 12 key risk factors (TABLE), and advocates cardiovascular referral for patients who show positive findings.
TABLE 12 cardiovascular risk factors to watch for during preparticipation physicals for school-aged athletes
Personal history
1.
Exertional chest pain or discomfort
2.
Unexplained syncope or near-syncope (exertional syncope is of particular concern)
3.
Excessive exertional and unexplained dyspnea or fatigue associated with exercise
4.
Previous recognition of a heart murmur
5.
Elevated systemic blood pressure
Family history
6.
Premature death (sudden and unexpected or otherwise) in one or more relatives <50 years old because of heart disease
7.
Disability from heart disease in a close relative <50 years
8.
Relatives with: hypertrophic or dilated cardiomyopathy, long QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias
Physical examination
9.
Heart murmur—perform auscultation in both supine and standing positions (or with Valsalva maneuver), specifically to identify murmurs of dynamic left ventricular outflow tract obstructions
10.
Femoral pulses to exclude aortic coarctation
11.
Physical stigmata of Marfan syndrome
12.
Brachial artery blood pressure (sitting position), preferably in both arms
