Sports Medicine: Just the Facts

CHAPTER 12 • THE PREPARTICIPATION PHYSICAL EXAMINATION 71

c. Origin of coronary artery from pulmonary artery

d. Coronary artery hypoplasia

• Symptoms: exertional chest pain or syncope


• Diagnosis: angiogram

MARFAN’SSYNDROME

• Diagnosis: need two of four major features
  a. Family history.
  b. Cardiovascular abnormality (aortic aneurysm, mitral
  valve prolapse, congestive heart failure symptoms)
  c. Musculoskeletal abnormality (arm span more than
  height, kyphoscoliosis, anterior thoracic deformity)
  d. Ocular abnormality (ectopic lens, myopia)


• If suspected, should get genetic and cardiology con-
  sults (include echocardiogram). See suggested screen-
  ing formal for Marfan’s syndrome (Table 12-6).

CORONARYARTERYDISEASE

• Consider exercise stress testing for the following:
  a. Male over 45; female over 55
  b. Those with risk factors: diabetic, smoker, family his-
  tory of heart disease, total cholesterol over 250, high-
  density lipoprotein(HDL) cholesterol under 30
  c. Anyone with exertional chest pain, syncope, or
  palpitations

VALVULARDISORDERS

• Aortic stenosis: This often results in sudden death,
  with or without exercise.
  •Mitral valve prolapse: this is not a risk factor for
  sudden death.

CARDIACCONDUCTIONSYSTEMABNORMALITIES

• Idiopathic long QT syndrome
  a. QT interval greater than 440 ms
  b. Frequently suspected in cases of sudden death in
  which no structural heart problems are found
  c. May produce syncope or near syncope

SCREENING FOR SUDDEN DEATH

• History: family history; syncope, exertional chest
  pain or dyspnea on exertion.


• Examination:Marfan’s habitus; murmur.


• EKG/CXR:reassuring if both normal


• Exercise stress test, Holter, and angiogramshould be
  done as indicated by history and examination findings.

ATHLETICHEART CANCOMPLICATESCREENING

• Athletic heart is the normal adaptation of a healthy
  heart to exercise.

TABLE 12-4(b) The Classification of Sports by Contact

CONTACT/COLLISION LIMITED CONTACT NONCONTACT

Basketball Baseball Archery
Boxing Bicycling Badminton
Diving Cheerleading Body building
Field hockey Canoeing/kayaking (white water) Bowling
Football (flag or tackle) Fencing Canoeing/kayaking (flat water)
Ice hockey Field Crew/rowing
Lacrosse High jump Curling
Martial arts Pole vault Dancing
Rodeo Floor hockey Field
Rugby Gymnastics Discus
Ski jumping Handball Javelin
Soccer Horseback riding Shot put
Team handball Racquetball Golf
Water polo Skating Orienteering
Wrestling Ice Power lifting
— Inline Race walking
— Roller Riflery
— Skiing Rope jumping
— Cross country Running
—Downhill Sailing
—Water Scuba diving
— Softball Strength training
— Squash Swimming
— Ultimate Frisbee Table tennis
—Volleyball Tennis
—Windsurfing/surfing Track
——Weight lifting

SOURCE: American Academy of Pediatrics, Committee on Sports Medicine, Recommendations for Participation
in Competitive Sports, Pediatrics1998.