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Table 1 The 14-element AHA recommendation for pre-participation cardiovascular screening of competitive athletes

From: Routine pre-employment echocardiography assessment in young adults: cost and benefits

Medical history (parental verification recommended for high school and middle school athletes)

Personal history

1.Exertional chest pain/discomfort

2.Exertional syncope or near-syncope

3.Excessive exertional and unexplained fatigue/fatigue associated with exercise

4.Prior recognition of a heart murmur

5.Elevated systemic blood pressure

6.Prior restriction from participation in sports

7.Prior testing for the heart ordered by a physician

Family history

8.Premature death–sudden and unexpected before age 50 year due to heart disease, in one or more relatives

9.Disability from heart disease in a close relative < 50 years old

10.Specific knowledge of certain cardiac conditions in family members:

hypertrophic or dilated cardiomyopathy, long QT syndrome or other ion channelopathies, Marfan syndrome, or clinically important arrhythmias

Physical exam

11. Heart Murmur—exam supine and standing or with Valsalva, specifically to identify murmurs of dynamic L ventricular outflow tract obstruction

12. Femoral pulses to exclude aortic stenosis

13. Physical stigmata of Marfan syndrome

14. Brachial artery blood pressure (sitting, preferably taken in both arms)

  1. Positive/abnormal screen warrants further evaluation and 12-lead EKG
  2. AHA does Not currently recommend routine 12-lead ECG