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]
peer reviewed journal and is available as a ACC webex video. The recommendations are specific for High School athletes (Figure 1), College and Professional athletes (Adults, Figure 2) and Master athletes (Figure 3). The experts also recommended adapted criteria for Myocarditis (Table 1). They presented specific cautions regarding the use of Magnetic Resonance Imaging (MRI) until pathological changes can be differentiated from those due to exercise training. The risk level of symptoms is provided in Table 2.. As you will see, these experts have observed that cardiovascular consequences of Covid-19 are relatively mild and so when compared to initial recommendations at the beginning of the pandemic, they have lessened indications for cardiac testing prior to return to play.
It is assumed that the sport and exercise are performed consistent with current physical distancing, appropriate hygienic measures and face mask guidelines. Note that routine testing for the virus using a resting ECG looking for the repolarization changes associated with myopericarditis are not included at this time. Age and severity of illness have been emphasized and should be taken into account when considering cardiovascular diagnostics. Note also that at this time the benefits of exercise far outweigh the risk of exercise-induced cardio-pulmonary damage in the young. Our committee promulgates these recommendations with the caveat that they may be superseded by other guidelines as new knowledge comes available.
The pathology (fibrosis, inflammation and thrombosis) of damage to the heart and lungs has been demonstrated but their time course and severity are uncertain but appear to be mild in athletes. Also it is not certain to what degree exercise training can exacerbate the damage caused by the pathogen but the experience so far is that this appears to be minor as well.
Table 1. Adapted Criteria for Myocarditis
Myocarditis (Probable Acute Myocarditis With Both of the Following Criteria)1. Clinical syndrome, including acute heart failure, angina-type chest pain, or known myopericarditis of less than 3 months’ duration.
2. Otherwise unexplained increase in serum troponin levels, ECG repolarization abnormalities, arrhythmias or high-grade atrioventricular block, abnormal ventricular wall motion, or pericardial effusion. Additional cardiac MRI findings that suggest myocarditis.
Sports Eligibility Myocarditis Recommendations1. Before returning to sports, athletes diagnosed with a clinical syndrome consistent with myocarditis should undergo a resting echocardiogram, ambulatory ECG monitoring, and an exercise test no less than 3 to 6 mo after the illness.
2. It is reasonable that athletes can resume training and/or competition if all of the following criteria are met:
A. Ventricular systolic function has normalized.
B. Serum markers of myocardial injury, heart failure, and inflammation have returned to normal levels.
C. Clinically relevant arrhythmias are absent.
Table 2. Risk levels of Symptoms
1. Mild Symptomsinclude anosmia, ageusia, headache, mild fatigue, mild upper respiratory tract illness, and mild gastrointestinal illness;
2. Moderate Symptomsinclude persistent fever, chills, myalgias, lethargy, dyspnea, and chest tightness;
3. Severe Symptomsinclude dyspnea, exercise intolerance, chest tightness, dizziness, syncope, and palpitations which often require hospitalization.
Figure 1. Coronavirus Disease 2019 (COVID-19) Return-to-Play Algorithm for Athletes in Competitive High School Sports
Figure 1 used by permission.
Legend:CDC - US Centers for Disease Control and Prevention; ECG, 12-lead ECG/EKG; echo, echocardiogram; hs-cTn, high-sensitivity cardiac troponin-I; RTP, return to play.
Figure 2. Coronavirus Disease 2019 (COVID-19) Return-to-Play Algorithm for Collegiate and Professional Athletes in Competitive Sports
Figure 2 used by permission.
Figure 3. Coronavirus Disease 2019 (COVID-19) Return-to-Play Algorithm for Recreational Masters Athletes
Figure 3 used by permission.
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