Pre-Participation Physical Exam Primary Purposes of PPE Detect medical or musculoskeletal conditions that might predispose an athlete to injury or illness during athletic participation Detect potentially life-threatening (cardiovascular) conditions that might limit an athlete s safe participation Address legal or insurance requirements Secondary Purposes of PPE Determine general health of athlete Counsel the athlete Assess fitness level for specific sports 1
General Components of PPE Medical history Personal Family Inspection BP & pulse Auscultation Special tests????? Success of PPE & Cardiac Screening in US 1996 retrospective study only 4/115 (3%) trained athletes who died from SCD were identified during PPE as having a cardiac disorder Italy s PPE & Cardiac Screening 1979-1996 33,735 athletes 35 years old were screened 3016 (8.9%) were referred for echocardiogram 22 were diagnosed with HCM 621 (1.8%) athletes were disqualified from participation 2
Minimum Components of PPE (American Heart Association) Family history Premature or sudden death in relative < 50 yrs Specific knowledge of close relatives with certain CV conditions HCM Marfan syndrome Arrythmias Long QT syndrome Minimum Components of PPE (American Heart Association) Personal history Excessive, unexplained fatigue associated with exercise Excessive, unexplained shortness of breath associated with exercise Exertional chest pain Exertional syncope Heart murmur Hypertension Minimum Components of PPE (American Heart Association) Physical examination Auscultation of heart in both supine & standing positions Palpation of femoral pulses Recognition of S & S of Marfan s syndrome Blood pressure 3
Minimum Components of PPE (American Heart Association) Parental verification of personal & family history for high school athletes ATCs Role in PPE Usually responsible for organization Should ensure AHA minimum standards Should utilize variety of MDs and allied health professionals Orthopedists Internists General Practitioners Nurse practitioners Others Results of PPE What if athlete has positive history? What about cardiac conditions that require special tests for detection? What if special tests diagnose significant CV condition? 4
Medical Tests Electrocardiogram (ECG) Echocardiograms Electron-beam computed tomography Cardiac magnetic resonance imaging (CMR) Coronary artery angiography Exercise testing Electrocardiogram (ECG or EKG) Measures the electrical activity of the heart at rest during exercise (stress test) Echocardiogram Diagnostic ultrasound of the heart Size of chambers Pumping function Valve function 5
Electron-Beam Computed Tomography Faster than standard CT Capable of showing calcium buildup within arteries Coronary artery angiography X-ray procedure that shows the coronary arteries Catheter inserted into the heart by way of an artery from the leg or arm Coronary Artery Angiography Die is injected through the catheter that shows narrowing or blockage of arteries 6
Cardiac magnetic resonance imaging (CMR) New study being used to look at heart soft tissue and function Recommendations of 36th Bethesda Conference Provide guidelines for making decisions about safe participation with known CV conditions Sport Classifications The Role of AEDs in Preventing Sudden Cardiac Death 7
Role of AED in Preventing SCD Time to defibrillation is the most important factor in survival from sudden cardiac death Survival rates from onset to defibrillation 2-3 min 50% 4-5 min 25% or less 10 min 10% or less Role of AED in Preventing SCD Recommendations from 36 th Bethesda Conference 1. AEDs should be available at educational facilities that have competitive athletic programs (including intramural sports and conditioning classes), stadiums, arenas, and training sites, with trained responders indentified among the permanent staff. Devices should be deployed so as to provide a response time of less than 5 min. Role of AED in Preventing SCD Recommendations from 36 th Bethesda Conference 2. Initial response to a suspected or identified cardiac arrest should be to contact emergency medical services (911), followed immediately by, or concomitant with, initiating CPR and deploying AED 8
Role of AED in Preventing SCD Recommendations from NATA 1. AED program should be part of an athletic trainer s EAP 2. AED should be part of every athletic trainer s standard emergency equipment 3. Athletic trainers should take a primary role in implementing comprehensive AED program in their work setting. NATA Official Statement on AEDs (www.nata.org) Questions? 9