Cardiovascular screening: tailoring the preparticipation exam.

Abstract

While the critical task of the preparticipation cardiac examination is identifying life-threatening conditions, care must be taken not to exclude healthy individuals from activity. The vast majority of exams will be negative, but the physician should be alert to such potentially lethal conditions as hypertrophic cardiomyopathy, aortic stenosis, and Marfan syndrome. A history of symptoms during exertion, certain features of physical appearance, and clinical findings require referral to a cardiologist. Although the cardiac examination needn't involve complex tests, it must permit recognition of abnormal heart sounds and other signs of pathology. In the older athlete, coronary heart disease is the principal risk, and the examination should be tailored accordingly.