For clearance to participate in sports, The American Academy of Family Physicians recommends the following:

Athletes with a murmur that becomes softer with squatting or louder or longer with standing or during a Valsalva maneuver should be evaluated for hypertrophic cardiomyopathy and mitral valve prolapse.

For clearance to participate in sports, The American Academy of Family Physicians recommends against following:

Routine screening with noninvasive tests, such as echocardiography, exercise stress testing, and electrocardiography is not recommended

If this blog has one mission in life - besides to amuse and entertain - it is to prevent those in the medical profession from doing excess harm. Lord knows, there are plenty of people out there who would have been much better off had they never come in contact with the medical profession. As doctors, we can't always help people. But, at the very least, I think it is incumbent upon us to become proficient at not harming our patients. And, one of the best and easiest ways to prevent harm to our patients is to decline to screen them for things that they don't need to be screened for!

Whether or not we should screen for hypertrophic cardiomyopathy in order to prevent sudden death in young athletes is controversial. Currently, there is no evidence to support it, but more studies need to be done. HOWEVER, if there is no evidence to support routine screening with ECG or echo, then you can be damn well positive that there isn't any evidence to support routine screening with cardiac ascultation!

This happens rather frequently in medicine. I'm thinking particularly about the recent controversy over the new age recommendations for routine mammography. Whenever the evidence points us in a direction contrary to what health care professionals believe to be their beneficent duty, we end up with recommendations that simply don't make sense.

I've got to go to the local high school and do some sports physicals this afternoon.