PREPARTICIPATION EVALUATION

Contraindications to sports participation: reccs come from "26th Bethesda Conference" J. Am. Coll. Cardiol. 24:845, 1994, cited in Phys. Sportsmed. 24:47, 1996

I. Hypertrophic cardiomyopathy

  1. The leading cause of sudden crdiac death in athletes younger than 30yo
  2. Often have h/o exertional syncope, dizziness, or chest pain
  3. Systolic murmur that increases with Valsalva
  4. Thickened ventricular septum on Echo
  5. If symptomatic, shouldn't play sports; if asymptomatic, should only do low-intensity sports

II. Mitral valve prolapse

  1. Only limit sports participation if documented arrhythmogenic syncope, repetitive SVT or other arrhythmia, family h/o sudden death ass'd with MVP, h/o thromboembolism (if any, can only do low-intensity sports)

III. Wolff-Parkinson-White sd.

  1. If no structural heart disease and asymptomatic, can do all spors; otherwise, limit to low-intensity sports

IV. Long QT sd.-must not do any sports; high risk of sudden death with activity

V. Other cardiac conditions that may limit participation: aortic stenosis, coarctation of aorta (usually dx'd before a sports physical takes place), myocarditis, HTN

VI. Sz disorders-if well controlled can do any sports, even though head trauma may precipitate sz in people with epilepsy; don't do sports where a sz could result in death (weight lifting, archery, swimming)

VII. Concussion hx (see also "head trauma" under Neurology)

  1. Classification schemes: there are several, all assign grade according to:
  1. Confusion or no
  2. Amnesia or no and if so, how long
  3. LOC or no and if so, how long
  1. Example of one, from Nelson et al. (Phys Sportsmed 12:103, 1984)
  1. Grade 0: no initial confusion, subsequent c/o HA and difficulty concentrating
  2. Grade 1: "Stunned or dazed" initially but < 1 min, no LOC or amnesia
  3. Grade 2: "Stunned or dazed" > 1 min, no LOC, may have amnesia, irritability, HA, dizziness, or tinnitus
  4. Grade 3: LOC < 1 min but not comatose; grade 2 sx after regaining consciousness
  5. Grade 4: LOC > 1 min but not comatose; grade 2 sx after regaining consciousness
  1. Reccs for return to play
  1. If sensorium doesn't clear quickly or if had amnesia, LOC, dizziness, HA, or any other sx, shouldn't return to game (e.g. grade 0 or 1 above)
  2. Cantu (Phys Sportsmed 14:75, 1986) reccs minimum 1wk removal from play for any concussion and return at that point if asymptomatic; longer removal for severe concussion (min. 1 mo) or previous concussion ever; reccs terminating season for any 3rd concussion however mild
  3. Returning to play too soon puts pt at risk for "second impact sd." in which rapid cerebral edema can lead to death