Preparticipation Cardiovascular Screening Update

Paul W. Baumert, Jr., M.D., FAAFP

 

Sports Medicine Rounds

April 26, 2007

Cardiac Issues

 

•      Preparticipation

 

•      Athletic activity

 

•      Return to play

 

Gold Standard

 

•      36th Bethesda Conference 

•      Eligibility Recommendations for Competitive Athletes With Cardiovascular Abnormalities

    Journal of the American College of Cardiology 45: 1312-1375, 2005

Bethesda Conference

 

•      Classification of sports

 

•    Dynamic

 

•    Static

Bethesda Conference

•      Congenital heart disease

•      Acquired valvular heart disease

•      Hypertrophic cardiomyopathy, myocarditis, myopericardial diseases and mitral valve prolapse

•      Systemic hypertension

•      Coronary artery disease

•      Arrhythmias

Preparticipation Screening

•      American Heart Association

    Cardiovascular Preparticipation Screening of Competitive Athletes

    Circulation 94(4): 850-856, Aug. 15, 1996

 

AHA 12 Elements (2007) 

 

•      Personal history (5)

 

•      Family history (3)

 

•      Physical examination (4)

Preparticipation Screening

•      Personal history

•    Exertional chest pain/discomfort

•    Unexplained syncope/near syncope (not neurocardiogenic)

•    Excessive exertional and unexplained dyspnea/fatigue, associated with exercise

•    Prior recognition of a heart murmur

•    Elevated systemic blood pressure

Preparticipation Screening

•      Family history

•     Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease in > 1 relative

•     Disability from heart disease in a close relative < 50 years of age

•     Specific knowledge of certain heart conditions in family members, i.e. HCM or dilated CM, long QT/other ion channelopathies, Marfan’s syndrome, or other clinically important arrhythmias

Preparticipation Screening

•      Physical examination

•    Brachial artery blood pressure (sitting position)

•   Preferably taken in both arms

•    Physical stigmata of Marfan’s syndrome

•    Auscultation for heart murmur

•   Supine and standing (or with Valsalva)

•   Noting any changes with maneuvers

•    Femoral pulses

Available Diagnostic Testing

•      ECG

•      ECHO

•      Serum cholesterol

•      Holter monitor

•      Event monitor

•      Treadmill

 

•      EP studies

•      Cardiac MRI

•      Coronary angiogram

2007 Panel Statement

•      Mandated screening 12-lead EKG (ESC and IOC) is:

•    Impractical in U.S.

•    Requires considerable resources (nonexistent)

•    Result in false positive test results

•   Further testing

•   Anxiety

•   Possible disqualification without merit

•    Does not arbitrarily oppose individual programs

Practical Approach

•      Obtain personal and family CV history

•    Get medical records

•      Appropriate physical examination

•    Refer if indicated

•      Review guidelines

•    36th Bethesda Conference, 2005

•      Make specific recommendations