The Cardiovascular Preparticipation Evaluation (PPE) for the Primary Care and Sports Medicine Physician, Part I
In the article appearing on pages 246–267 of the May/June 2015 issue, the following errors were detected:
Victor F. Froelicher, MD, FACSM
Professor of Cardiovascular Medicine and Orthopedics/Sports Medicine
Director Sports Cardiology Clinic, Stanford University
Center for Inherited Cardiovascular Disease
870 Quarry Road
Falk Cardiovascular Research Building; MC-5406/Room CV-285
Stanford, CA 94305-5406
Current Sports Medicine Reports.
Purpose: To provide a rational approach to positive responses to the American Heart Association (AHA) 12-Step Questionnaire and fourth-edition “Preparticipation Physical Evaluation” (PPE) monograph for assessing cardiovascular (CV) risk in athletes. This will assist primary care and sports medicine physicians in determining the need for the following:
- Follow-up questions to a positive response that will enhance the history and help determine whether a condition that puts an athlete at increased CV risk exists
- Any basic diagnostic tests to further assess the athlete and that will assist with making an informed decision
- The need for a consultation or referral to an appropriate specialist
Our goal is to help the primary care and sports medicine physician with the critical decision making regarding positive responses to the AHA 12-Step Questionnaire and criteria for athlete clearance, as follows:
- Could this be a potentially lethal problem?
- Does this need additional workup or just an electrocardiogram?
- Does this require consultation with a specialist (and which specialty)?
For example, to address a positive response to the question regarding “excessive shortness of breath or fatigue with exercise beyond what is expected for your level of fitness,” it would be useful for physicians to know which elements in the history, physical, or diagnostic tests point to a potentially lethal CV diagnosis versus an easily treated pulmonary issue like exercise-induced asthma. If a lethal diagnosis can be excluded, the responsible physician may be able to determine that no restriction is warranted and clear the athlete for appropriate activity without a referral to a cardiologist or another specialist.
While there are some differences in the questions from the AHA 12 points and the CV questions in the PPE fourth-edition monograph, the underlying intent is the same and the information provided is easily utilized for both question sets.Copyright © 2015 by the American College of Sports Medicine.