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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. 11024