Sports Physical

An athlete may look entirely well while sitting in a clinic and still have a cardiovascular condition that becomes dangerous when exercise increases heart rate, blood pressure, contractility, and myocardial oxygen demand. The cardiovascular portion of a preparticipation physical evaluation (PPE) is intended to detect or raise suspicion of genetic, congenital, or acquired disease associated with sudden cardiac death (SCD), not to guarantee that every future event can be predicted. Conditions of concern include hypertrophic cardiomyopathy (HCM), arrhythmogenic cardiomyopathy, anomalous coronary artery origin, myocarditis, aortopathy associated with disorders such as Marfan syndrome, and primary electrical disorders such as long QT syndrome. These conditions create different hazards: ventricular arrhythmia, impaired ventricular filling or outflow, myocardial ischemia, inflammation-related pump failure, or aortic dissection. Exercise can expose a problem that is silent at rest. The first-tier screen is therefore deliberately clinical. A detailed history may reveal risk that a normal resting pulse, normal oxygen saturation, or apparently athletic appearance cannot.