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Am Fam Physician. 2007;76(10):1568-1569

Guideline source: American Heart Association

Literature search described? No

Evidence rating system used? No

Published source: Circulation, March 27, 2007

There has been a recent increase in sudden deaths among young competitive athletes with undetected cardiovascular disease (CVD) in the United States and Europe. Because many official recommendations from athletic governing bodies are inconsistent and lack standardization, and therefore may be medically insufficient, the American Heart Association (AHA) has issued recommendations that address the benefits, limitations, and medical implications of preparticipation screening in high school and college athletes.

CVD is a common cause of sudden death in young athletes; hypertrophic cardiomyopathy is the most common cause of death of athletes, representing one third of all deaths. These deaths occur most often in basketball and football players in the United States. Identifying these abnormalities through preparticipation cardiovascular screening could prevent sudden death in this population.

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There is a need for uniform guidelines for preparticipation screening of young athletes, so the AHA recommends that a national standard for cardiovascular evaluations be developed for high school and college athletes. To raise suspicion of CVD in young athletes, the AHA recommends that a personal and family medical history be taken and a physical examination be performed (Table 1). Uniform guidelines may identify more athletes with cardiac disease, ensure the safety of competitive sports, and positively affect the health of these athletes. In addition, providing a practical screening strategy for a large population of young athletes will ensure that complete family and personal medical histories are taken, which may identify CVD that could progress or cause sudden death.

Preparticipation screening examinations should be performed in an environment conducive to optimal auscultation of the heart; however, performing echocardiography or electrocardiography is optional. Physical examinations should be mandatory for all competitive athletes before they are allowed to play organized sports. For high school athletes, these evaluations should be given every two years. College athletes also should complete family and personal medical histories before they are allowed to compete; these histories should be updated and the athlete's blood pressure should be measured every three years. Changes in medical status may mean that further testing is required or that another physical examination should be performed.

Cardiovascular athletic screening should be performed only by physicians and other health care professionals who are trained to recognize signs of CVD. Parents should be responsible for completing their child's medical history, and student athletes with any identified abnormalities should be referred to a subspecialist.

The AHA notes that restricting young athletes who are at risk of cardiac disease is justified by the tremendous impact of sudden deaths in this population.

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