cardiology consult
The key question I would like to ask are if this patient has ever had a cardiology consult, any cardiac testing (such as EKG, ECHO), and more information as far as the symptoms. With symptoms like these I am not going to want to clear him for sports. I would want an assessment and clearance from cardiology. If cardiology cant get to the root of the issue than further testing may need to be done on my end to find a cause. Passing out, concussions, and becoming ill in the heat are all red flags for cardiac causes.
I would perform a head-to-toe examination including neurologic, cardiac, pulmonary, ROM, ect. This would give me a full picture of the patient and note any abnormalities that could point to cause of the patients previous syncopal issues. During my physical exam I would pay particular attention to the cardiac system for any murmurs, presence of S3/S4, any palpable heaves, lifts or thrills. If a murmur is noted we would want to have the patient preform some physical maneuvers to see if the murmur changes with activity or different positions (Farzam, Rajasurya, 2023). I would want to do orthostatic blood pressures and an EKG. I would want to assess or more likely have the cardiologist assess for cardiac abnormalities due to cardiac arrest in young athletes during competitive play is usually linked to cardiac issues of congenital origins (Farzam, Rajasurya, 2023). Some conditions that can present with syncope or even cardiac arrest are hypertrophic obstructive cardiomyopathy, arrhythmogenic right ventricular dysplasia, and coronary artery anomalies (Farzam, Rajasurya, 2023). We would want a cardiologist to be on board to further assess for these issues. As far as my history I would want to ensure that the patient isn’t using any performance enhancing drugs such as steroids that can cause cardiac issues (Farzam, Rajasurya, 2023).
As stated above I would refer this patient to a cardiologist for further cardiac testing. I would want cardiac clearance before I would clear this patient to do any strenuous activities including football. Once we have a more definitive diagnosis from cardiology I would include school administrators and any coaches in the child’s diagnosis. I would writer a letter to these individuals with clear instructions as to what the patient can and cannot do. I would also provide information on any warning signs. I would also want to provide specific instructions in terms of concussions. The patient is 16 and already has a history of previous concussions. Athletes who have had concussions in before are at an increased risk (3-5times) to have another concussions (Tsushima, Siu, et al., 2019). Repeat concussions have been shown to have detrimental effects on the brain and especially in youths when the brain isn’t fully developed. Repeated concussions in this age group should be avoided at all costs. I would provide this education to the parents and the patient. I would want them to make an informed decision when it comes to continuing to play football.
Billing Code: CPT 99212, DX code Z02.5
Farzam K, Rajasurya V, Ahmad T. Sudden Death in Athletes. [Updated 2023 Jul 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539708/
Tsushima, W. T., Siu, A. M., Ahn, H. J., Chang, B. L., & Murata, N. M. (2019). Incidence and Risk of Concussions in Youth Athletes: Comparisons of Age, Sex, Concussion History, Sport, and Football Position. Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists, 34(1), 60–69. https://doi.org/10.1093/arclin/acy019
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