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INTRODUCTION

Physical activity is extremely beneficial for the cardiovascular (CV) health of children. In the United States, the prevalence of obesity has nearly tripled since 1980. Large autopsy studies have shown that the atherosclerotic process begins in childhood and childhood obesity is a strong risk factor for adult obesity. These data highlight the importance of engaging children in regular physical activity early in life. Exercise increases cardiac work by increasing the heart rate and stroke volume, which is easily accommodated by a normal heart. Some CV diseases can impose limitations to normal exercise performance and can lead to sudden cardiac death (SCD), especially if undetected.

Sports preparticipation screening is performed to uncover and diagnose CV abnormalities that can impact on the safety of exercise activities and/or sports participation. In the United States, approximately 64 to 76 SCD events occur annually on the athletic field, and there are an estimated 10 to 12 million children and adolescents participating in organized sports. Between 2001 and 2006, the incidence of SCD in these athletes was reported as 0.61 in 100,000 person-years, which, although rare, carries with it tragic consequences for families, schools, and communities. Hypertrophic cardiomyopathy remains the most common cause of SCD in young athletes, accounting for approximately 36% of cases. Anomalous aortic origin of a coronary artery arising from the wrong sinus of Valsalva is the second most common cause, accounting for approximately 17% of cases. Other less frequent CV conditions include myocarditis, dilated cardiomyopathy, channelopathies (eg, long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia), arrhythmogenic right ventricular cardiomyopathy, commotio cordis, Wolff-Parkinson-White syndrome, previous Kawasaki disease with undiagnosed coronary involvement, and connective tissues disorders associated with aortopathy, for example Marfan syndrome.

SCREENING STRATEGY

Despite many years of strong debate as to the best approach to preparticipation screening, personal and family medical history, as well as physical exam, remain central to most programs in the United States. Thus, the personal history can help uncover warning signs (eg, chest pain, exertional syncope, dyspnea), while a detailed family history provides clues to many genetically transmitted CV diseases. Careful physical exam can help to detect murmurs from septal defects, valvar heart disease, or left ventricular outflow tract obstruction as occurs in hypertrophic cardiomyopathy. The 14-point screening system recommended by the American Heart Association (AHA) (Table 493-1) is a comprehensive tool that can be used by primary care providers to identify clues to underlying heart disease. It has been recommended that patients with the presence of 1 or more criteria should undergo further workup.

TABLE 493-1THE 14-ELEMENT AMERICAN HEART ASSOCIATION (AHA) RECOMMENDATIONS FOR PREPARTICIPATION CARDIOVASCULAR SCREENING OF COMPETITIVE ATHLETES

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