One of the most important parts of the preparticipation physical exam (PPE) most sports programs require is the taking of a complete medical history. Regardless of what PPE form their child's program uses, the following questions should be asked during the pre-participation physical evaluation or exam (e.g. sports physical):
1. Family medical history. Has anyone in the athlete's family:
- Died for no apparent reason (SIDS, car accident, drowning)?
- Had a heart problem?
- Died of heart problems or sudden cardiac arrest before age 50?
- Had syncope (fainting) or presyncope (near fainting)?
- Had unexplained seizures?
- Had significant arrhythmia (irregular heartbeat) or a pacemaker?
- Had any of the following genetic disorders:
- Hypertrophic cardiomyopathy (HCM). Note, however, that one study found that only 25% of athletes with HCM who died of sudden cardiac death had a family history of one or more non-traumatic familial deaths at age 50 or younger.
- Dilated cardiomyopathy (DCM)
- Marfan syndrome
- Ehlers-Danlos syndrome
- Arrythmogenic right ventricular cardiomyopathy
- Early coronary artery disease
- Brugada syndrome
- Long QT syndrome (LQTS)
- Short QT syndrome
- Primary pulmonary hypertension
- Rheumatic fever
- Hypertension (high blood pressure) or
- Kawaski disease?
2. Personal Medical History
- Has the child ever experienced:
- Chest pain with or without exercise?
- Excessive, unexpected, or unexplained fatigue with exercise?
- Excessive, unexpected, or unexplained shortness of breath with exercise? (Note: doctors don't always recognize this as a symptom of congenital heart disease, sometimes mistaking it for exercise-induced asthma. In one case, a 15-year-old boy was pulled out of a soccer game because of shortness of breath and later diagnosed with asthma. A month later, he suffered sudden cardiac death on a soccer field as a result of HCM)
- Heart palpitations (heart races or skips beats) during exercise?
- Past detection of a heart murmur or high blood pressure?
- Skin (warts, fungus, blisters, boils or skin infections)
- Neurologic (detailed concussion history): Has the athlete experienced or is he experiencing
- Heat illness
- Asthma or Seasonal Allergies (asthma should be suspected in any athlete with a history of wheezing during sports)
- Diet and weight concerns (i.e. eating disorders)
- Psychosocial Issues:
- home life and family dynamics
- school performance and relationships
- activities (sports, jobs, and leisure enjoyment
- safety issues (violence, weapon use, vehicular recklessness)
- suicidal tendencies
- Alcohol, drugs, tobacco, stimulant use, steroids, and/or sexual practice issues (contraception, type, number, and frequency of partners)
- The fourth edition of the Preparticipation Physical Evaluation monograph will feature a revamped health questionnaire focused on cardiac health problems that may be exacerbated by physical activity, making additional questions about stimulant use, including energy-drink consumption, important.
- Primary amenorrhea (absence of periods by age 16) or secondary amenorrhea (absence of period for more than three cycles) that may indicate that the athlete is suffering from the female athlete triad.
Revised February 16, 2011
Editor's Note: On May 13, 2010, the PPE Campaign and Coalition for Youth Sports Health and Safety was launched to promote the widespread adoption and consistent use of an updated preparticipation physical evaluation form (PPE) for pre-competition medical screening of U.S. student-athletes. The coalition includes as founding partners leading medical organizations, sports governing bodies and other groups, including MomsTeam, in its tenth year of promoting youth sports safety. For more on the PPE Coalition, click here.