a. Physiologic hypertrophy of an athlete’s heart in
response to exercise can approach that seen with
HCM (but left ventricle or LV end diastolic cavity
dimensions remain normal).
b. These changes reverse when exercise intensity
decreased.
•Will see EKG, radiographic and Echo changes of car-
diac enlargement and enhanced vagal tone.
a. EKG often shows resting bradycardia, sinus
arrhythmia, 1°atrioventricular(AV) block, Mobitz
type 1 (Wenkebach) 2°AV block, and junctional
rhythms. These changes reverse during exercise
and increased sympathetic tone.
b. Clinical examination often shows bradycardia, S3
or S4 heart sounds, and innocent flow murmurs.REFERENCES
American College of Sports Medicine, American College of
Cardiology. 26th Bethesda Conference: Recommendations for
determining eligibility for competition in athletes with cardio-
vascular abnormalities. Med Sci Sports Exerc 26(10):
5223–5283, 1994.
Franklin BA, Fletcher GF, Gordon NF, et al: Cardiovascular eval-
uation of the athlete. Sports Med24:97–119, 1997.
Koester KC, Amundson CL: Preparticipation screening of high
school athletes. Phys Sportsmed31(8):35–38, 2003.
Kurowski K, Chandran S: The preparticipation athletic evalua-
tion. Am Fam Physician61(9):2683–2690, 2000.
Maron BJ, Thompson PD, Puffer JC, et al: Cardiovascular
preparticipation screening of competitive athletes. Circulation
94:850–856, 1996.74 SECTION 1 • GENERAL CONSIDERATIONS IN SPORTS MEDICINE
FIG. 12-2 Sample clearance form, used to communicate findings on the preparticipation examina-
tion to parents and team officials. (From Preparticipation Physical Evaluation, 2nd ed. American
Academy of Family Physicians, The Physician and Sportsmedicine, McGraw-Hill Healthcare
Minneapolis, Minnesota, 1997)
Table 12-6 Suggested Screening Format to Look for
Marfan’s Syndrome
Screen men over 6 ft and women over 5 ft 10 in. in height with an
echocardiogram and slit-lamp examination when any two of the
following are found:
- Family history of Marfan’s syndrome*
- Cardiac murmur or mid-systolic click
- Kyphoscoliosis
- Anterior thoracic deformity
- Arm span greater than height
- Upper to lower body ratio more than one standard deviation below
the mean - Myopia
- Ectopic lens
- This finding aloneshould prompt further investigation.
SOURCE: Hara JH, Puffer JC: in Mellion MB: Sports Injuries &
Athletic Problems. Philadelphia. Hanley & Belfus, 1988.