The Cardiovascular Preparticipation Evaluation (PPE) for the Primary Care and Sports Medicine Physician, Part II

This article aims 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:

1. 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.
2. Any basic diagnostic tests to further assess the athlete and that will assist in making an informed decision.
3. 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:

1. Could this be a potentially lethal problem?
2. Does this need additional workup or just an electrocardiogram (ECG)?
3. Does this require consultation with a specialist (and which specialty)?

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.

This is the second of this two-part Special Communication. Part 1 published in the May/June 2015 issue of Current Sports Medicine Reports and is available on the journal’s Web site [www.acsm-csmr.org].