Preparticipation Evaluation of the Athlete Heart:
Questionnaire and Resources
Introduction to Questionnaire and Videos for the Athlete
Exercise Health & Sports Cardiology Committee
- Victor Froelicher, MD, Stanford Sports Cardiology, Stanford Health Care, Professor Emeritus of Medicine (Cardiovascular) at the Palo Alto Veterans Affairs Health Care System
- Gerald Bourne, MD, FACC, The Adaptive Behavior Institute, Kensington, CA
- Elizabeth H. Dineen, DO, Cardiovascular Disease, University of California, Irvine Health
- For questions, contact us at SportsCardio@caacc.org
Why should you be concerned with answering these scary questions? Sure, heart problems and their complications including death are rare in young athletes. But what if the causes of these conditions and their complications were known and we knew their warning signs? Your parents, relatives and coaches would like you to be able to play sports safely. Modern medicine has made tools available for screening and treating heart conditions so why not take advantage of them? The first step in doing so is to watch these videos and answer these questions as best you can. Studies have shown us that they can be clues for recognizing the first signs of heart conditions. Your answers to these questions will be summarized for you to take to your annual screening for participation in organized sports with some suggestions for your doctor or organization to consider prior to sports participation. Even if you don’t have any of these symptoms now, you now know that if they ever occur they should be reported. Please share this resource with your teammates.
- Athlete Cardiovascular Risk Videos
- Suggestions for the Physician Performing the PPE
- Athlete COVID-19 Risk Questionnaire
- Pre Participation Exam (PPE) Screening
- Current Recommendations for Cardiac Evaluation during the Covid-19 Pandemic
- Resumption of Institutional Sports
- Resources & References
Videos are courtesy of the University of Texas Southwestern Medical Center (Dr. Benjamin Levine).
Cardiovascular Risk Questionnaire [View, Download, Print PDF]
Have you ever seen a doctor for a heart problem before?
Has a doctor ever ordered testing for your heart, such as an EKG/ECG, x-ray, Echocardiogram, MRI or an exercise stress test?
Has a doctor ever told you not to play sports before?
Have you ever had an unexplained seizure?
Do you take any performance supplements or energy drinks?
Print out this form and enter your answer
Covid Questionnaire for Young Athletes [View, Download, Print PDF]
Figure 1. Current Recommendations for Competitive Athletes and Highly Active People for Cardiac Testing and Exercise Limitations during the Covid-19 Pandemic
Figure 1 used by permission.
Legend:COVID-19 = coronavirus disease 2019
hsTn = high-sensitivity troponin I
RTP = return to play
a. Typical testing obtained via a nasopharyngeal swab. All athletes with positive testing should be isolated for 2 weeks regardless of symptoms.
b. If clinical and/or cardiac symptoms develop, follow appropriate clinical pathway.
c. The ACC/AHA athlete myocarditis guidelines are recommended. Some prefer the term “physical distancing” rather than “social distancing”.
Citations:Dermot Phelan, MD, PhD1; Jonathan H. Kim, MD, MSc2; Eugene H. Chung, MD, MSc3 JAMA Cardiol.
Published online May 13, 2020. doi:10.1001/jamacardio.2020.2136
We do not have good data from athletes yet but the following study in non-athletes raises concerns. It is known that pericarditis and myocarditis can occur long after SARS-CoV-2 infection. A cohort of 139 health-care workers with confirmed past COVID (103 diagnosed by RT-PCR and 36 by serology) were studied. Participants underwent PE, ECG, lab tests including immune cell profiling and cardiac MRI. At examination 10 1/2 weeks after symptoms, all participants were hemodynamically stable. Chest pain, dyspnea or palpitations were observed in 58 (42%) participants; EKG changes in 69 (50%); NT-pro-BNP was elevated in 11 (8%); troponin in 1 (1%); and cardiac MRI abnormalities in 104 (75%).The prevalence of pericarditis or myocarditis was high in both test groups 43% vs 31%. Pericarditis and myocarditis can occur months after COVID infection, even in presently asymptomatic, non-athletic subjects. Such studies need to be confirmed in athletes. https://www.medrxiv.org/content/10.1101/2020.07.12.20151316v1
These two articles from the lay press provide important balance to the current state of knowledge.
These are two news reports of young athletes who have died after recuperating from COVID-19:
1. To add value to our membership by educating our members
in diagnosis and treatment of athletes.
2. To raise the awareness of Exercise Health to the Californians
thereby reducing and preventing Cardiovascular related morbidity
The ACC is THE Professional Home for Cardiovascular Specialists and the Care TeamTo represent YOU, the ACC is actively working on:
Member Value and Engagement
Data, Information and Knowledge
Transformation of Care