When you hear of young athletes suddenly collapsing during practice, many parents undoubtedly became concerned about their own student athletes and the likelihood it could happen to them. Screening for conditions that can result in sudden cardiac event is one of the main goals of the pre-participation physical examination (PPE). We’ll start doing these exams on children when they become active in sports all the way up through high school, college and professional sports.
In Kansas the PPE is mandated for athletes starting in seventh grade. The PPE kit consists of two components: a history and then a physical.
The history component is very important. The things we want to really hit on in the history component is:
- Cardiac history for both the athlete and family members. Did a relative die of a heart condition at an early age?
- Exertional symptoms. Have you ever passed out when you’re exercising? Have you ever had exertional chest pain that’s different from just being out of shape? Exertional shortness of air that’s not proportional to how much you’re exercisin
- Family history. - Is there a family member that has died from unknown cardiac reasons before the age of 50? Did they die when they were exercising? - Is there a family history of heart problems that can be genetic such as Marfan syndrome or Long QT syndrome? There can be heart conditions such as connective tissue disorders, instances where channels in the heart don’t work properly, electrical abnormalities where the heart doesn’t pump properly due to the electrical circuit, or an over enlargement of the heart that is caused by abnormal growth of the heart muscle.
The other component of the PPE is the physical portion. Among the things we focus on are:
• Blood pressure check.
• Checking for a heart murmur. Does your child have a heart murmur? If so, does that need to be looked into? Sometimes murmurs are innocent, but some need to be further evaluated.
• Checking the pulse. There should not be a different pulse in the radial artery and the femoral artery.
• Looking for physical exam findings that would suggest Marfan syndrome, an inheritable genetic condition that affects the body's connective tissue. You have connective tissue throughout your whole body so it can virtually affect you anywhere. The most common areas that are affected are the aorta, which is a blood vessel that enables blood to flow out of the heart and to the body, the lens of the eyes, and the joints. For example, Marfan syndrome can make your aorta weak and more likely to rupture and can make the lens of eye more likely to dislocate.
Sports participation is important for young people. The PPE we have in place is a good screening tool to make sure student athletes are ready for play. Ideally the best scenario is to have your family’s primary care physician perform the PPE because the student athlete will have a relationship with that physician and they will have their medical history and probably know the history of others in the family. Your family doctor will be the first to pick up on any changes in the student athlete’s health.