Preparticipation Evaluation
Purpose and structure
The preparticipation evaluation screens for conditions that increase risk with exercise, identifies prior injuries, and establishes a baseline. History is the highest-yield component, detecting most abnormalities, with the physical examination adding cardiovascular and musculoskeletal findings. The American Heart Association 14-element screening history covers exertional symptoms, family history of sudden death or inheritable cardiac disease, prior murmurs, hypertension, and substance use. Most organizations favor a comprehensive evaluation at entry into a level of competition with annual updates.
Cardiovascular screening
Sudden cardiac death is the leading medical cause of death in athletes, most often from hypertrophic cardiomyopathy, anomalous coronary anatomy, and ion-channel disorders. Marfan screening looks for tall stature, arm span exceeding height, thumb and wrist signs, pectus deformity, and mitral valve prolapse. Auscultate supine and standing to unmask dynamic murmurs, palpate femoral pulses for coarctation, and measure blood pressure in the seated position with an appropriately sized cuff.
Musculoskeletal and other components
Include vision, general medical, and a focused joint examination; ask about prior concussions, heat illness, sickle cell trait, asthma, and eating behaviors. Athletes with Down syndrome warrant attention to atlantoaxial instability.
Traps
- Assuming a normal physical exam excludes structural heart disease.
- Believing universal ECG screening is mandated in the United States; it is not standard by AHA guidance.
- Clearing an athlete with unexplained exertional syncope.
- Missing that most abnormal findings come from history.
Rule of thumb: exertional syncope, exertional chest pain, or a family history of sudden death before age 50 means restriction and cardiology referral, not watchful waiting.