Preparticipation physical evaluation: getting to the heart of the matter.

The cardiovascular evaluation is an important component of the preparticipation physical examination of the athlete. The history should be standardized to include questions ranging from those about chest pain and palpitations to ones about syncope. The physical examination should not be a perfunctory one, but rather a careful search for findings that might include a low grade heart murmur that accentuates with Valsalva'a maneuver (suggestive of hypertrophic cardiomyopathy, the leading cause of sudden death in a competitive athlete). The cardiovascular risks to the athlete are known. Fortunately, only a small percentage of athletes who are screened have such abnormalities. The validity of such screening remains to be proven. Recommendations are provided to make the present approach more time efficient and perhaps more cost effective.