Vital Signs

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PE DIATRIC S Sports Physicals Offer Opportunity to Screen for Serious Conditions Sports physicals — a prerequisite for participation in high school athletics — represent an important opportunity to quickly screen for a variety of conditions that could place the young athlete at risk, according to Jason Hove, MD, a family medicine physician at UCLA Health in Redondo Beach, who provides exams for high school athletes. “This is a time when we can pose very specific questions about response to exercise,” Dr. Hove explains. “Often when children and adolescents go for their regular doctor visits, they aren’t asked about these specific sports-related issues.” The most important concerns for Dr. Hove and colleagues are cardiac conditions that can lead to sudden death when the athlete is at full exertion, the most common of which is known as hypertrophic obstructive cardiomyopathy. “This is a congenital condition that has nothing to do with your level of training,” Dr. Hove says. In the course of a sports physical, the physician asks about family history of heart disease or sudden death, as well as about any symptoms that have been experienced during exercise in the past — such as chest pain, shortness of breath or fainting — that could be a symptom of an underlying condition. During a cardiac exam the physician listens to all parts of the heart, and patients are asked to perform specific maneuvers that would bring out the murmurs that can be linked to the sudden death syndrome. “This is a very straightforward evaluation,” Dr. Hove says. “A primary-care physician can, with the appropriate guidelines, listen for a murmur. The vast majority of kids aren’t going to have it, but if they do, it needs to be further evaluated.” While heart conditions are the most serious, the sports physical is designed to detect a number of other potential red flags, Dr. Hove notes. One is a history of concussions, particularly for athletes in sports that are prone to them, such as football and soccer. A growing number of schools are having athletes in such sports take baseline Sports physicals represent an important opportunity to quickly screen for a variety of conditions that could place the young athlete at risk. neurocognitive tests so that the results can be compared with those on tests after a potential concussion during the season. Other conditions of interest in sports physicals include a history of asthma or other respiratory issues; any chronic-injury problem; and, for girls, the so-called female-athlete triad — characterized by being underweight and having irregular menstrual periods — leaving them particularly prone to experiencing stress fractures. Girls who are diagnosed with the latter condition can be helped with proper nutrition, Dr. Hove explains. “Many of these conditions do not preclude participation,” concludes Dr. Hove. “Some require a further workup, and others require further evaluation by a specialist. The important thing is to make sure that before any high school athlete is cleared to play, he or she has been appropriately screened.” Vital Signs Winter 2014 Vol. 61 11