Overview
Clinical Meaning
The preparticipation physical evaluation (PPE) aims to identify conditions predisposing athletes to sudden cardiac death (SCD), musculoskeletal injury, or heat illness.
The preparticipation physical evaluation (PPE) aims to identify conditions predisposing athletes to sudden cardiac death (SCD), musculoskeletal injury, or heat illness. SCD in athletes <35 years is primarily caused by structural cardiac abnormalities: hypertrophic cardiomyopathy (HCM, 36%), coronary artery anomalies (17%), arrhythmogenic right ventricular cardiomyopathy (ARVC, 11%), myocarditis (6%), and ion channel disorders (long QT syndrome, Brugada syndrome, catecholaminergic polymorphic VT). HCM involves mutations in sarcomeric protein genes (beta-myosin heavy chain, myosin-binding protein C) causing asymmetric septal hypertrophy (>= 15 mm in adults), myocyte disarray, and interstitial fibrosis, creating substrate for ventricular tachycardia/fibrillation during exercise. Coronary artery anomalies (anomalous origin of left coronary from right sinus with interarterial course) cause SCD through external compression between the aorta and pulmonary artery during exercise-induced aortic root expansion. In athletes >35 years, atherosclerotic coronary artery disease is the predominant cause. Commotio cordis (sudden cardiac arrest from blunt chest impact during the vulnerable phase of repolarization - T-wave window) occurs in youth sports with projectile impact. Exercise-induced physiologic cardiac remodeling (athlete's heart) must be distinguished from pathologic hypertrophy: athlete's heart shows symmetric LVH (typically...