Preparticipation Screening of Competitive Athletes

Abstract

Sports used to be simple. The major decision my friends and I faced as youngsters was who would get to be Y.A. Tittle of the New York Giants in our Sunday afternoon football pickup games. The preparticipation screening of athletes also used to be simple and generally consisted of a medical form completed by a parent and a cursory physical examination performed in the gym by a general physician. Now, recreation for many young Americans requires formal play dates, and there are T-ball leagues for those too young to hit an unsupported baseball. The preparticipation screening of athletes also has become more formalized and is, in some countries, a legally regulated activity.1 The goal of both increased athletic supervision and formalized preparticipation screening is to protect young athletes from the risks inherent in athletic participation, but how best to accomplish this goal is now in hot debate. Article p 1085 Screening athletes has received increased attention because the issue of sudden cardiac death (SCD) in athletes and during exercise has become a prominent health issue. Public interest in these events probably arises from both the importance of sport in many societies and the paradox that physical activity can have both a positive and negative impact on an individual’s health.2 It is clear that vigorous exertion transiently increases the risk of SCD in individuals with established cardiovascular disease.2 Atherosclerotic coronary artery disease is the primary pathological finding in individuals >40 years of age who die during physical activity, whereas inherited cardiovascular conditions are primarily responsible for such events in younger athletes.2 Hypertrophic cardiomyopathy (HCM), an entity described shortly before Tittle played for the Giants,3 accounts for most (36% to 44%) of these deaths in American athletes, with other abnormalities, including anomalous coronary arteries (17%), myocarditis (6%), …