Medical Evaluation of Athletes: Medical History and Physical Examination

Abstract

Medical history and physical examination still represent the basis of medical evaluation of athletes. Although the accuracy of detecting relevant underlying cardiovascular disease is only moderate, “red flag symptoms” as syncope, exertional chest pain, shortness of breath or palpitations should raise suspicion and prompt further assessment to complete the overall clinical image. Positive family history is a strong marker for genetically determined increased risk and further supports clinical suspicion. An accurate physical examination may efficiently reduce the number of unnecessary further examinations (e.g. by cardio-pulmonary auscultation) or enables to prompt specific and tailored further assessment of an athlete. Apart from current, highly sophisticated technical opportunities for the detection and diagnosis of cardiovascular disease, still the personal and in-depth clinical assessment of an athlete, performed by an experienced and dedicated sports physician, represents the basis of optimal medical care. This initial approach allows an intuitive interpretation based on the accurate assessment of the athlete’s personal, systemic and family history, as well as a focused physical examination. Nevertheless, as recent data impressively suggests: In the setting of primary screening to prevent sudden cardiac death in young athletes medical history and physical examination have a low yield of less than 50% yield to detect underlying disease in this population, and an ECG should be added.