Pre-athletic testing guidelines

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Updated by: Dr. Sara Creighton
Updated on: 5/2017

Recommendations for appropriate pre-athletics screening in patients without history of cardiac disease in the primary care setting and when to refer patients for cardiology evaluation.


Pre-participation screening for participation in competitive athletic competition with no known cardiac disease

Referring provider's initial evaluation and management:

Referring providers should utilize the 14 point questionnaire recommended by the American Heart Association (AHA)1:

Medical history

Personal history

  • Exertional chest pain/ discomfort
  • Unexplained syncope/ near-syncope
  • Excessive exertional and unexplained dyspnea/ fatigue associated with exercise
  • Prior heart murmur
  • Elevated blood pressure
  • Prior history of athletics restriction
  • Prior testing for the heart, ordered by a physician
  • Family history
  • Premature death before age 50 years due to heart disease in FIRST-degree family member
  • Disability from heart disease in a close relative younger than 50 years of age
  • Specific knowledge of cardiac disease in family members: Specifically, hypertrophic or dilated ardiomyopathy, Long QT syndrome, channelopathies, Marfan syndrome, or other inheritable arrhythmias

Physical exam

  • Weak or delayed femoral pulses
  • Fixed, split second heart sounds +/- murmur
  • Systolic murmur >3/6 or any diastolic murmur
  • Stigmata of connective tissue disease

What can referring provider send to cardiology clinic?

Please complete the Epic Internal Referral Order

Specialist's workup will likely include:

Depending on the symptoms patient presented with, work-up MAY include:

  • Echocardiogram
  • ECG
  • Stress Test (Exercise treadmill testing)
  • Ambulatory ECG monitoring (Holter or Event
  • Bloodwork (CBC, NT-proBNP, electrolytes)