(See also Sports and the Heart.)

Cardiovascular screening

Screening for all children and adults should include a thorough cardiovascular history, with questions about

• Known hypertension or heart murmur
• Chest pain
• Exercise-induced syncope, near-syncope, chest pain, or palpitations
• Family history of sudden cardiac death at age < 50 yr, arrhythmias, dilated or hypertrophic cardiomyopathy, long QT syndrome, or Marfan syndrome
• Risk factors for coronary artery disease in adults

Physical examination should routinely include BP, supine and standing cardiac auscultation, and inspection for features of Marfan syndrome. These measures aim to identify adults as well as rare, apparently healthy young people at high risk of life-threatening cardiac events (eg, people with arrhythmias, hypertrophic cardiomyopathy, or other structural heart disorders). Testing is directed at clinically suspected disorders (eg, exercise stress testing for coronary artery disease, echocardiography for structural heart disease, ECG for long QT syndrome).

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Other screening measures

Noncardiovascular risk factors are more common than cardiovascular risk factors. Adults are asked about arthritic disorders, particularly those involving major weight-bearing joints (eg, knees, ankles, hips).

Two at-risk populations are commonly overlooked:

• Boys who physically mature late or are short are at greater risk of injury in contact sports with larger and stronger children.
• Overweight or obese people who participate in activities that require high agility are at greater risk of injury due to sudden stops and starts because of excess body weight and associated forces on the joints and tissues.

Adolescents and young adults should be asked about use of illicit and performance-enhancing drugs. (See also the US Anti-Doping Agency web site.www.usantidoping.org.) In girls and young women, screening should detect delayed onset of menarche. Girls and young women should be screened for the presence of the female athlete triad (eating disorders, amenorrhea or other menstrual dysfunction, and diminished bone mineral density), which is becoming more common as more adolescent and young women engage in overly intensive physical activity and overly zealous loss of body fat.

Contraindications

There are almost no absolute contraindications to sports participation. Exceptions in children include

• Myocarditis, which increases the risk of sudden cardiac death
• Acute splenic enlargement because splenic rupture is a risk
• Fever, which decreases exercise tolerance, increases risk of heat-related disorders, and may be a sign of serious illness
• Possibly diarrhea and recent vomiting because dehydration is a risk

Exceptions in adults include angina pectoris and recent (within 6 wk) MI. Contraindications are more commonly relative and lead to recommendations for precautions or for participation in some sports rather than others. For example, people with a history of multiple concussions should participate in noncollision sports; males with a single testis should wear a protective cup for most contact sports; people at risk of heat intolerance and dehydration (eg, those with diabetes or cystic fibrosis) should hydrate frequently during activity; and people with suboptimal seizure control should avoid swimming, weight lifting, and sports such as archery and riflery because of risk to others.

Last full review/revision April 2009 by Brian D. Johnston; Paul L. Liebert, MD