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Diagnostic Approach after Initial Abnormal Screening

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Sports Cardiology

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Abstract

The cardiac evaluation of an athlete begins with a history and physical examination and sometimes includes a 12-lead electrocardiogram (ECG), depending upon local or organizational policies and practices. An understanding of symptoms and physical exam findings that warrant further evaluation, plus knowledge of expected and abnormal ECG findings in athletes, is essential to determine when, and if, further and more detailed downstream cardiac testing is required. When imaging beyond an ECG is indicated and requested, this downstream testing can encompass numerous cardiac tests and visits to subspecialists that have the potential to incur significant cost, time, anxiety, and continued uncertainty. Fundamental downstream tests commonly requested and used in the cardiac evaluation of highly active individuals and competitive athletes include transthoracic echocardiograms, cardiac magnetic resonance imaging, coronary computed tomography angiography, and stress testing. Each of these tests has strengths and weaknesses in their ability to provide additive diagnostic information and to help distinguish physiologic athletic cardiac remodeling from potential underlying cardiac pathology. This chapter will focus on and outline how to best utilize multimodality imaging for the assessment of athletes who may present for an evaluation after a pre-participation screening exam, for athletes with new or evolving symptoms, for asymptomatic older athletes, and for younger athletes with congenital heart disease. A well-constructed plan for downstream testing can diagnose and risk stratify athletes in a streamlined fashion and limit unnecessary testing and expense while avoiding a prolonged return to play timeline.

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Authors and Affiliations

  1. Director of Sports Cardiology, Morristown Medical Center, Atlantic Health System, Morristown, NJ, USA

    Matthew W. Martinez

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  1. Matthew W. Martinez
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Correspondence to Matthew W. Martinez .

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  1. Division of Cardiology, Columbia University Irving Medical Center, New York, NY, USA

    David J. Engel

  2. Sports Cardiology Center, Hypertrophic Cardiomyopathy Center Atrium Health Sanger Heart & Vascular Institute, Charlotte, NC, USA

    Dermot M. Phelan

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Martinez, M.W. (2021). Diagnostic Approach after Initial Abnormal Screening. In: Engel, D.J., Phelan, D.M. (eds) Sports Cardiology. Springer, Cham. https://doi.org/10.1007/978-3-030-69384-8_3

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  • DOI: https://doi.org/10.1007/978-3-030-69384-8_3

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