Preparticipation Evaluation and Screening
Core concepts
Know the goals of the preparticipation physical evaluation (PPE): detect conditions that increase risk, promote health, and meet legal/organizational requirements. Understand the AHA 14-point screening elements: personal history of heart disease, syncope, chest pain with exercise, family history of sudden death, and physical exam findings (murmur, Marfan features, femoral pulses). Understand that the PPE is not a substitute for comprehensive care and that mass screening has limits (low prevalence, false positives). Know when to restrict participation (e.g., uncontrolled hypertension, active myocarditis, symptomatic cardiac disease).
Traps
Questions test whether you over-order tests: routine ECG screening in asymptomatic young athletes is controversial and not universally recommended; do not order it reflexively. Do not clear an athlete with exertional syncope or a family history of sudden death without cardiology evaluation. Another trap is missing that the PPE should include cardiovascular, musculoskeletal, and general health components, not just a sports clearance form.
Rule of thumb
Any "yes" on the cardiovascular history (syncope, chest pain with exercise, family sudden death) triggers further evaluation before clearance. A murmur that worsens with Valsalva or standing suggests hypertrophic cardiomyopathy; one that decreases suggests benign flow murmur.
Worked example
A 17-year-old basketball player reports fainting during a game last season. This is exertional syncope and requires cardiology evaluation (ECG, echocardiogram) before clearance; do not clear based on a normal physical exam alone.