It's customary for young athletes to need a doctor's exam before being allowed to play on the school team. What should it include? According to new guidelines by the American Heart Association, a simple 12-step screening process could help reduce sudden cardiac deaths in young athletes. The recommended screening process includes 12 questions about personal and family medical history and a physical examination.

"Although the frequency of these deaths in young athletes appears to be relatively low, it is more common than previously thought and does represent a substantive public health problem," says Dr. Barry J. Maron, chair of the panel that wrote the new screening guidelines.

About one in 200,000 high school athletes die from a heart attack while on the playing field. Most deaths occur among football and basketball players, according to studies.

The Dream Screen

What should doctors screen in your young athlete? According to the AHA guidelines, physicians should ask questions about…

  • Chest pain/discomfort upon exertion .Unexplained fainting or near-fainting
  • Excessive and unexplained fatigue associated with exercise
  • Heart murmur
  • Family history, asking specifically about one or more relatives who died of heart disease (sudden/unexpected or otherwise) before age 50, and
  • Any close relative under age 50 with disability from heart disease
  • Specific knowledge of certain cardiac conditions in family members such as hypertrophic or dilated cardiomyopathy, in which the heart cavity or wall becomes enlarged; "long QT syndrome," which affects the heart's electrical rhythm; or Marfan syndrome, in which the walls of the heart's major arteries are weakened.

The physical examination should note…

  • Heart murmur
  • Blood pressure
  • Femoral pulses to exclude narrowing of the aorta
  • Physical appearance of Marfan syndrome
  • Brachial artery blood pressure taken in a sitting position).

If any of the 12 screening elements indicate potential problems, the patient should be referred for further cardiovascular examination before joining a sports team.

Surprising Athletic Predictor

A study of 607 female twins found that the A difference in lengths between the second and fourth (ring) fingers indicated athletic ability. Women with ring fingers longer than their index fingers (typical in men) were more likely to excel in running, soccer and tennis.

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