Athletic Preparticipation Screening Guidelines
The American Heart Association has published guidelines for pre participation sports physicials. The HCMA encourages each State to use these guidelines when updating there requirements for participation in high schools and college level programs. In addition the HCMA believes the same questions should be asked of those children participating in recreational level athletics and “club” teams.
Hypertrophic cardiomyopathy is a condition that is generally not compatable with competitive athletics and therefore those with HCM should not participate in most athletic programs. HCM is the leading cause of sudden cardiac arrest in young athletes.
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American Heart Pre-participation Guidelines:
The American Heart Association Guidelines indicate the following information should be obtained about each student athlete prior to participation. In addition the HCMA suggests that children and young adults who have been adopted or are in any way unsure about their family history be viewed as potentially at risk and follow up with a comprehensive cardiac evaluation as noted below.
|1. Exertional chest pain/discomfort|
|2. Unexplained syncope/near-syncope|
|3. Excessive exertional and unexplained dyspnea(shortness of breath)/fatigue, associated with exercise|
|4. Prior recognition of a heart murmur|
|5. Elevated systemic blood pressure|
|6. Premature death (sudden and unexpected, or otherwise) before age 50 years due to heart disease, in 1 relative|
|7. Disability from heart disease in a close relative <50 years of age|
|8. Specific knowledge of certain cardiac conditions in family members: hypertrophic or dilated cardiomyopathy, long-QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias|
|9. Heart murmur|
|10. Femoral pulses to exclude aortic coarctation|
|11. Physical stigmata of Marfan syndrome|
|12. Brachial artery blood pressure (sitting position)|
|*Parental verification is recommended for high school and middle school athletes.|
|Judged not to be neurocardiogenic (vasovagal); of particular concern when related to exertion.|
|Auscultation should be performed in both supine and standing positions (or with Valsalva maneuver), specifically to identify murmurs of dynamic left ventricular outflow tract obstruction.|
Preferably taken in both arms.At the discretion of the examiner, a positive response or finding in any 1 or more of the 12 items may be judged sufficient to trigger a referral for cardiovascular evaluation. Parental verification of the responses is regarded as essential for high school (and middle school) students.
**Cardiovascular screening should include ECG, echocardiogram, possible stress test, possible cardiac MRI and follow up plan as needed. In the opinion of the HCMA, these tests should be conducted by a cardiac professional, not a general practitioner or pediatrician.
Maron, B.J. and Salberg, L. Hypertrophic Cardiomyopathy: For patients, their families and interested physicians. Blackwell Futura: 1st edition 2001,81 pages; 2nd edition 2006, 113 pages; 3rd edition pending publication 2014
Gersh, B.J., Maron, B.J., Bonow, R.O., Dearani, J.A., Fifer, M.A., Link, M.S., et al. (2011). 2011 ACCF/AHA guidelines for the diagnosis and treatment of hypertrophic cardiomyopathy. A report of the American College of Cardiology Foundation/American Heart Asociation Task Force on practice guidelines. Journal of the American College of Cardiology and Circulation, 58, e212-260.
Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, Shah PM, Spencer WH, Spirito P, ten Cate FJ, Wigle ED. American College of Cardiology/European Society of Cardiology Clinical Expert Consensus Document on Hypertrophic Cardiomyopathy. A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines Committee to Develop an Expert Consensus Document on Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2003;42:1687-1713 and Eur Heart J 2003;24:1965-1991.
Maron BJ, Thompson PD, Ackerman MJ, Balady G, Berger S, Cohen D, Dimeff R, Douglas PS, Glover DW, Hutter AM Jr, Krauss MD, Maron MS, Mitten MJ, Roberts WO, Puffer JC. Recommendations and considerations related to pre-participation screening for cardiovascular abnormalities in competitive athletes: 2007 update: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism: endorsed by the American College of Cardiology Foundation. American Heart Association Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007 Mar 27;115(12):1643-455.
Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation. 2006 Oct 10;114(15):1633-44.