Download Pre-Participation Cardiovascular Screening for Youth Athletes

The Heart Center
Pre-Participation
Cardiovascular Screening for
Youth Athletes
An estimated 22 million children age 6 to 17 years
participate in team sports in the United States each
year. Most of these young athletes must undergo
a physical exam each year as a requirement for
participation. These exams are intended to identify
any potential medical issues that may affect a child’s
ability to compete in certain sports, including
cardiovascular conditions.
Nationwide Children’s Hospital supports efforts to
improve the cardiovascular health of young athletes,
including advocating for American Heart Associationrecommended pre-participation cardiovascular
screenings in young athletes and the availability of
automated external defibrillators (AEDs) in schools and
training programs designed to teach school personnel
to use these life-saving devices.
The guidelines for cardiac screening in young athletes
set forth by the American Heart Association (AHA)
were developed by a team of leading pediatric
cardiologists from around the country and were
updated in 2014. These recommendations, which
call for a comprehensive personal and family medical
history and physical examination (including brachial
artery blood pressure measurement), are designed
to identify or “raise the suspicion” of cardiovascular
diseases linked to sudden cardiac death or disease
progression in young athletes.
The AHA recommends that this medical evaluation
be performed by a qualified examiner and include the
14 key AHA-recommended elements for personal and
family history-taking and physical examination, as
well as parental verification of the medical history for
high school and middle school student-athletes (see
table). Examinations should be conducted in a physical
environment conducive to optimal auscultation of the
heart. Obtaining echocardiograms and/or ECGs as part
of preparticipation screening remains optional.
We follow the 14-Element AHA Recommendations
for Preparticipation Cardiovascular Screening of
Competitive Athletes.
At the discretion of the examiner, a positive response
or finding in any 1 or more of the 14 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.
continued
The 14-Element AHA Cardiovascular Screening Checklist for Congenital and Genetic Heart Disease
Personal history
Yes No
  1. Chest pain/discomfort/tightness/pressure related to exertion


2. Unexplained syncope/near-syncope*


3. Excessive exertional and unexplained dyspnea/fatigue or palpitations, associated with exercise


4. Prior recognition of a heart murmur


5. Elevated systemic blood pressure


6. Prior restriction from participation in sports


7. Prior testing for the heart, ordered by a physician
Family history
Yes No
  8. Premature death (sudden and unexpected, or otherwise) before age 50 attributable to heart
disease in ≥1 relative
9. Disability from heart disease in close relative <50 y of age
  10. Hypertrophic or dilated cardiomyopathy, long-QT syndrome, or other ion channelopathies,
Marfan syndrome, or clinically significant arrhythmias; specific knowledge of certain cardiac
conditions in family members


Physical Examination
Yes No
  11. Heart murmur**


12. Femoral pulses to exclude aortic coarctation


13. Physical stigmata of Marfan syndrome


14. Brachial artery blood pressure (sitting position)***
*Judged not to be of neurocardiogenic (vasovagal) origin; of particular concern when occurring during or after physical exertion.
**Refers to heart murmurs judged likely to be organic and unlikely to be innocent; auscultation should be performed with the patient
in both the supine and standing positions (or with Valsalva maneuver), specifically to identify murmurs of dynamic left ventricular
outflow tract obstruction.
***Preferably taken in both arms.
Reference:
Maron BJ, Friedman RA, Kligfield P, Levine BD, Viskin S, Chaitman BR, Okin PM, Saul JP, Salberg L, Van Hare
GF, Soliman EZ, Chen J, Matherne GP, Bolling SF, Mitten MJ, Caplan A, Balady GJ, Thompson PD. Assessment
of the 12-Lead Electrocardiogram as a Screening Test for Detection of Cardiovascular Disease in Healthy General
Populations of Young People (12-25 Years of Age). Journal of the American College of Cardiology. 2014;64(14):1479-1514.
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