AIM of Preparticipation Evaluation

• Identify pre-existing cardiac abnormalities clinically silent
• To recognise very early possible risks, signs and symptoms of underlying cardiovascular disease
• Ensure optimal management
• Reducing potential for adverse events and loss of life during exercisetraining and competetive sport participation
• After screening to recommend how to perform sports and activities for prevention, rehabilitation and therapy

European Guidelines

Family history: + if

• close relative(s) had experienced a premature heart attack or sudden death (<55 years of age in males and <65 years in females) OR
• presence of a family history of cardiomyopathy, Marfan syndrome, long QT syndrome, Brugada syndrome, severe arrhythmias, coronary artery disease, or other disabling cardiovascular diseases.

Personal history: + if

• exertional chest pain or discomfort
• syncope or near-syncope
• irregular heartbeat or palpitations
• shortness of breath, or fatigue out of proportion to the degree of exertion.

Physical examination: + if

• musculoskeletal and ocular features suggestive of Marfan syndrome
• Diminished and delayed femoral artery pulses
• mid- or end systolic clicks, a second heart sound single or widely split and fixed with respiration, marked heart murmurs
• irregular heart rhythm
• brachial blood pressure > 140/90 mmHg (on > 1 reading)

Resting ECG

• ECG- can detect the most common causes of death
  • in the US - not common, due to low incidence in young people. you can also detect pathological adaptations that are no longer pathological
    

Pros and Cons of resting ECG

• Sensitivity and Specificity
  • Questionnaire alone
    • Family history may not be known
    • Conditions are often clinically silent
    • Symptoms not recognised or suppressed – subjective - non-specific
  • • Physical examination
      • Allows potential pick-up cardiac murmurs (HCM, bicuspid aortic valve, MVP) and coarctation, Marfan’s
      • HCM may be present without murmur, misses other cardiomyopathies and conduction disorders

Role of electrocardiogram

• ECG
  • Improves pick-up of cardiomyopathies or channelopathies
    • Sensitivity (= true positives)) improves from < 25% to > 90% with ECG
    • Unable to detect anomalies of coronary arteries,, adrenergically driven ion channel disorders, premature CAD!!!
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