Fourteen Questions Before the Signature: A Preparticipation Examination for a 15-Year-Old Basketball Player With a Cousin Who Died Young, and What the History Found That the Stethoscope Could Not
[Student Name]
University of Phoenix
NRP/543: Management of Pediatric and Adolescent Populations
Week 7 Assignment
[Instructor Name]
[Date]
The adolescent and family are composites written for a model paper.
Jalen, a 15-year-old guard on his high school basketball team, comes for his preparticipation physical examination with his mother, who needs a form signed. He feels well and has played for years without problems. On the questionnaire, his mother notes that her nephew, Jalen's cousin, "died in his sleep" at 22, with no cause found. This paper describes how that detail shaped the visit.
Why Screening Matters
Sudden cardiac death is the leading medical cause of death in young athletes. In a study of all National Collegiate Athletic Association athlete deaths from 2003 to 2013, sudden cardiac death accounted for 15% of deaths, occurring in about 1 in 53,703 athlete-years, with male athletes, Black athletes and basketball players at substantially higher risk; the most common autopsy finding was a structurally normal heart, sudden unexplained death (Harmon et al., 2015). Many underlying conditions are inherited, including hypertrophic cardiomyopathy and inherited arrhythmia syndromes such as long QT syndrome.
The 14-Element Screen
The American Heart Association recommends a 14-element personal history, family history and physical examination for preparticipation cardiac screening (Maron et al., 2007). The personal history asks about exertional chest pain, unexplained fainting or near-fainting, especially with exercise, excessive exertional breathlessness or fatigue, prior recognition of a heart murmur and elevated blood pressure. The family history asks about premature death, sudden and unexpected or otherwise, before age 50 due to heart disease in a relative, disability from heart disease in a close relative under 50 and specific knowledge of cardiac conditions such as cardiomyopathy, long QT syndrome or Marfan syndrome in family members. The examination includes a heart murmur check in the supine and standing positions, femoral pulses, Marfan syndrome features and brachial blood pressure.
Jalen's Answers
Jalen denies chest pain, fainting, unusual breathlessness, palpitations and prior murmurs. His blood pressure is 118/72 mm Hg. His examination is normal: no murmur supine, standing or with Valsalva, normal femoral pulses and no features of Marfan syndrome. The only positive element is the family history of sudden unexplained death in a relative under 50.
Every part of Jalen's examination was normal, and the one question that mattered was answered by his mother, not his heart.
Why an ECG
The American Heart Association recommendations did not endorse routine ECG screening for all U.S. athletes (Maron et al., 2007), but a positive history element warrants further evaluation. A cousin's sudden unexplained death at 22 raises the possibility of an inherited arrhythmia syndrome or cardiomyopathy in the family, some of which show ECG abnormalities before symptoms. I obtain a 12-lead ECG today and ask the family to obtain any autopsy or medical records from the cousin's death.
Reading the ECG
Athletes' ECGs often show changes from training, such as sinus bradycardia and increased QRS voltage, that would be abnormal in nonathletes. The international criteria for ECG interpretation in athletes separate normal training-related findings from abnormal findings that require further evaluation, such as T-wave inversion beyond certain leads, pathological Q waves, a long QT interval or pre-excitation (Drezner et al., 2017). Jalen's ECG shows sinus bradycardia at 56 beats per minute and increased QRS voltage, both normal training-related findings, and a corrected QT interval of 420 milliseconds, within normal limits. There are no abnormal findings.
The Decision
With a normal history of symptoms, a normal examination and a normal ECG by athlete-specific criteria, Jalen can be cleared for participation. Because the family history remains concerning, I recommend referral to a pediatric cardiologist for consideration of an echocardiogram and, depending on the cousin's records, genetic counseling for the family, and I explain that clearance can be revisited if new information emerges.
Why Not Routine ECGs for Everyone
Some countries screen all athletes with ECGs, and the international criteria were designed to reduce false-positive results when they do (Drezner et al., 2017). U.S. recommendations have not required universal ECG screening, citing false positives, costs, the number of athletes and the capacity to evaluate abnormal results (Maron et al., 2007). The debate continues. For Jalen, the question is simpler: his family history is a specific reason to test.
What the Cousin's Records Could Show
If the cousin's autopsy found hypertrophic cardiomyopathy, Jalen would need an echocardiogram and possibly genetic testing. If it showed a structurally normal heart, an inherited arrhythmia syndrome such as long QT syndrome or Brugada syndrome would be considered, and genetic testing of the cousin's stored tissue, if available, could guide testing of relatives. Without records, cardiology may still recommend an echocardiogram and possibly an exercise test.
Talking With Jalen
Jalen worries that he will be kept off the team. I explain that his tests today are reassuring, that he is cleared and that the cardiology visit is a precaution because of his cousin, not because anything is wrong with him. Adolescents are more likely to report symptoms honestly when they trust that reporting will not automatically end their season.
The Rest of the Adolescent Visit
A sports physical is often an adolescent's only visit of the year. I spend time alone with Jalen, explaining that what he tells me is confidential unless someone's safety is at risk. I ask about home, school, activities, drugs and alcohol, sexuality, mood and safety. He reports good grades, a supportive family, occasional vaping at parties and no depressive symptoms on a brief screen. I discuss vaping risks and ways to decline, and review sleep, nutrition, concussion symptoms and heat illness prevention for summer training.
Immunizations and Other Screening
Jalen is due for his meningococcal booster at 16; his HPV series is complete. His vision is normal.
Teaching
I teach Jalen and his mother the warning signs that should stop play and prompt evaluation: chest pain, fainting or near-fainting with exercise, palpitations and unusual breathlessness. I also confirm that his school has an automated external defibrillator and an emergency action plan, since early defibrillation is the most important factor in surviving sudden cardiac arrest.
Documentation
The note records each of the 14 screening elements with the answer, the family history detail, the ECG findings interpreted by athlete criteria and the clearance decision with its conditions. If Jalen's cousin's records later change the picture, anyone reviewing his chart will see exactly what was known when he was cleared.
Heat and Hydration
Summer basketball camps bring heat illness risk. I review signs of heat exhaustion and heat stroke, the need for water breaks and gradual acclimatization during the first two weeks of practice.
Conclusion
Jalen's preparticipation examination was normal except for one family history element, a cousin's sudden unexplained death at 22, which justified an ECG. Read with international athlete criteria, the ECG showed only normal training changes, and Jalen was cleared with cardiology referral for the family history. The visit also served his broader adolescent health through confidential screening, vaping counseling and teaching about warning signs.
References
Drezner, J. A., Sharma, S., Baggish, A., Papadakis, M., Wilson, M. G., Prutkin, J. M., La Gerche, A., Ackerman, M. J., Borjesson, M., Salerno, J. C., Asif, I. M., Owens, D. S., Chung, E. H., Emery, M. S., Froelicher, V. F., Heidbuchel, H., Adamuz, C., Asplund, C. A., Cohen, G., . . . Corrado, D. (2017). International criteria for electrocardiographic interpretation in athletes: Consensus statement. British Journal of Sports Medicine, 51(9), 704-731. https://doi.org/10.1136/bjsports-2016-097331
Harmon, K. G., Asif, I. M., Maleszewski, J. J., Owens, D. S., Prutkin, J. M., Salerno, J. C., Zigman, M. L., Ellenbogen, R., Rao, A. L., Ackerman, M. J., & Drezner, J. A. (2015). Incidence, cause, and comparative frequency of sudden cardiac death in National Collegiate Athletic Association athletes: A decade in review. Circulation, 132(1), 10-19. https://doi.org/10.1161/CIRCULATIONAHA.115.015431
Maron, B. J., Thompson, P. D., Ackerman, M. J., Balady, G., Berger, S., Cohen, D., Dimeff, R., Douglas, P. S., Glover, D. W., Hutter, A. M., Jr., Krauss, M. D., Maron, M. S., Mitten, M. J., Roberts, W. O., & Puffer, J. C. (2007). Recommendations and considerations related to preparticipation screening for cardiovascular abnormalities in competitive athletes: 2007 update. Circulation, 115(12), 1643-1655. https://doi.org/10.1161/CIRCULATIONAHA.107.181423
How this NRP 543 Week 7 example is structured
The NRP/543 Week 7 work usually addresses adolescent health, including risk screening and anticipatory guidance. This paper uses a common adolescent visit, the sports physical, to show how history questions detect cardiac risk, when testing goes beyond the standard examination and how the visit also serves the adolescent's broader health. Students search this week as NRP 543 Week 7, NRP543 Wk 7 or NRP/543 Wk 7; all three are the same assignment.
NRP/543 Week 7 questions, answered
What does NRP/543 Week 7 usually ask for?
Many sections ask students to address adolescent health, including confidential screening, risk behaviors and preventive care.
What should a preparticipation cardiac screen include?
The American Heart Association recommends a 14-element history and physical examination covering personal symptoms, family history of early sudden death or heart disease and examination findings such as murmurs and features of Marfan syndrome.
Should every young athlete have an ECG?
U.S. recommendations do not require routine ECGs for all athletes, but an ECG is appropriate when the history or examination raises concern, such as a family history of sudden unexplained death at a young age.
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