Page 63 - Athletic Health Handbook
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Non-Invasive Screening Table 1: Prevalence of Cardiac Cause Sudden Death

The use of ancillary cardiac testing Hypertrophic Cardiomyopathy 36%
for screening (mainly electrocardio-
grams [ECGs] and echocardiograms) Coronary Anomalies 19%
has, for the most part, not been shown
to be cost effective. Also, it has not Increased Cardiac Mass 10%
been widely accepted as a standard of
care for the preparticipation cardiac Ruptured Aorta 5%
exam. However, ECG, echocardio-
gram, or Holter monitor may be Tunneled Left Anterior 5%
indicated after a careful cardiac history Descending Coronary Artery
and physical examination. Potential
reasons for obtaining an ECG include: Aortic Stenosis 4%

History of exertional chest pain/ Myocarditis 3%
discomfort, syncope/near syncopal,
unexplained shortness of breath, Dilated Cardiomyopathy 3%
or fatigue associated with exercise.
Detection of a heart murmur or Arrhythmogenic Right 3%
hypertension on physical exam. Ventricular Dysplasia
History of palpitations or skipped
heart beats. Mitral Valve Prolapse 2%

Clearance Guidelines Coronary Artery Disease 2%

Guidelines for cardiac clearance Other 8%
were set by the National Institutes of
Health (NIH) 26th Bethesda Confer- Source: Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular pre-partici-
ence for Cardiovascular Abnormalities pation screening of competitive athletes. Circulation. 1996. 94:850-856.
and are published in a monograph
organized by the American Academy Table 2
of Family Physicians, American Criteria for Hypertension in Girls
Academy of Pediatrics, American
Medical Society for Sports Medicine, Age 50th Percentile for Height 75th Percentile for Height
American Orthopaedic Society for
Sports Medicine, and American 6 111/73 112/73
Osteopathic Academy of Sports
Medicine.4 These practical guidelines 12 123/80 124/81
cover the major cardiac abnormalities
seen in athletes including hyperten- 17 129/84 130/85
sion, arrhythmias, congenital heart
disease, acquired valvular disease, Criteria for Hypertension in Boys
ischemic heart disease, and cardiomy-
opathies. Recommendations for Age 50th Percentile for Height 75th Percentile for Height
clearance are based on sport contact
and sport strenuousness. 6 114/74 115/75

Athletes with mild to moderate 12 123/81 125/82
hypertension without evidence of
end organ damage may compete in 17 136/87 138/88
all categories of sport and should
have frequent monitoring of blood Source: Kurowski K, Chandran S. The pre-participation athletic evaluation.
pressure. The athlete should avoid Am Fam Phys. 2000. 61:2683-2690.
heavy weight lifting until they are
normotensive and focus on aerobic mitral regurgitation.5 Clearance for
conditioning.5 Athletes with severe participation should be determined
hypertension are not allowed to on a case-by-case basis if any of these
compete and need to be evaluated criteria apply.
and treated before eligibility for
participation can be determined. Athletes with an unequivocal diag-
nosis of HCM should not compete in
Benign functional murmurs do high- to moderate-intensity sports.
not preclude participation; however, Depending on the degree of HCM
mitral valve prolapse (MVP) warrants abnormality, some athletes may
further investigation when accompa- participate in low-intensity sports. In
nied by one of the following: (1) these cases, recommendations should
history of syncope due to arrhythmia, be made on an individual basis.
(2) family history of sudden death
attributed to MVP, (3) prior embolic Cardiac clearance pertaining to
event, (4) arrhythmia worsened by cardiac arrhythmias is beyond the
exercise, or (5) moderate to severe scope of this article, but each case
should be approached in an individual

PRE-PARTICIPATION EXAM AND CARDIAC RISK 63
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