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Sports Preparticipation Exam an Important Part of Back-to-School Time for Student Athletes.

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The sudden or premature death of a close or distant relative due to heart disease should be reported to your physician -- especially if the relative was younger than 50, says the AHA. Additional red flags to be brought to your physician's attention are heart murmur, high blood pressure, tiring easily, a history of fainting, shortness of breath, and chest pain upon exertion.

Other conditions that should be reported are palpitations, or irregular heartbeats, during or after exercise. If you know the student has high cholesterol levels, has had a recent viral illness, or has ever been restricted from participation in sports for heart reasons before, you should also mention this to your physician.

The authors recommend that athletes be encouraged to report recent legal and illegal drug use -- which includes alcohol and tobacco -- and eating disorders. These may be more difficult to elicit from the student, but they are very important.

Christopher C. Erickson, MD, tells WebMD that changes in tolerance to physical activity and change in general health should also be noted. Erickson is an associate professor of pediatric electrophysiology and pacing at the University of Arkansas/Arkansas Children's Hospital in Little Rock.

Strasburger adds that the AHA recommends that the PPE be performed by a licensed physician, and the exam should be done in a quiet room with enough time for the physician to get a thorough family history of health problems. The physician should take the student's blood pressure and listen to the heart while the student is standing and seated.

If sudden cardiac death is such a real (if rare) possibility, should all potential athletes be given more extensive cardiac exams such as ultrasounds, electrocardiograms, or heart stress tests?

No, says Strasburger. Some countries do this for their student athletes, but there are often many false positive results. Also, no scientific studies have shown that more testing would necessarily yield better results.

Erickson also reminds parents that, along with the heart history, students participating in sports should also have a complete orthopaedic evaluation to make sure they are physically capable of performing their chosen athletic activity. Student athletes should have a physical exam every year.

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