The purpose of the cardiac portion of the preparticipation physical evaluation is to identify potential health risks in young athletes, particularly sudden cardiac death. The preparticipation evaluation begins with a detailed screening questionnaire. Sudden cardiac death in athletes is considered rare, but the incidence in athletes is higher than in the general population. Leading causes of sudden cardiac death include hypertrophic cardiomyopathy, coronary artery anomalies, myocarditis, arrhythmogenic right ventricular cardiomyopathy, and aortic dissection. It also can be due to ventricular fibrillation, sometimes preceded by ventricular tachycardia. Electrocardiogram results may be abnormal in athletes who are at risk for sudden cardiac death, but diagnosis is made using cardiac imaging. Guidelines exist with recommendations for return to play for athletes who are at risk for sudden cardiac death.

Case 2. AS is a 15-year-old patient brought to your office after passing out at soccer practice. He was running drills when he suddenly lost consciousness. He reports no prior syncope, and he has no history of chest pain or pressure with exercise.

Evaluation

The purpose of the preparticipation physical evaluation is to identify potential health risks in young athletes. The cardiac portion of the evaluation attempts to identify athletes who are at risk of sudden cardiac arrest.¹