Title: Pediatric Cardiology / Sports Cardiology
Tags: peds-cardio sports sports-cardiology high-yield ecg return-to-play aaoca red-flags scd screening abnormal causes covid exam family-history hcm history lqts murmur myocarditis normal qtc shared-decision-making statistics syncope wpw

Q: What screening is recommended for all athletes before participation?
A: History + physical examination (14-element AHA screening)

Q: Is routine ECG screening recommended for all young athletes in the US?
A: No - AHA recommends H+P only; ECG may be considered based on resources

Q: What percentage of young athlete sudden cardiac deaths have warning symptoms?
A: Only ~20% have prodromal symptoms

Q: What are the most common causes of SCD in young athletes?
A: HCM (most common overall), coronary anomalies (AAOCA), arrhythmogenic cardiomyopathy

Q: What symptoms in an athlete's history warrant cardiac evaluation?
A: Exertional syncope, chest pain, palpitations, dyspnea out of proportion, family history SCD <50

Q: What family history warrants further evaluation before sports clearance?
A: SCD in first-degree relative <50 years, known HCM/LQTS/Marfan in family

Q: Does vasovagal syncope during exercise require evaluation?
A: Yes - exertional syncope is always concerning; post-exertional vasovagal may be benign

Q: What physical findings warrant further cardiac evaluation in athletes?
A: Murmur that increases with Valsalva, irregular rhythm, BP discrepancy, Marfanoid features

Q: How can you differentiate innocent from pathologic murmurs during PPE?
A: Innocent: decreases with Valsalva/standing; HCM murmur: increases with Valsalva/standing

Q: What ECG findings in athletes are considered normal variants?
A: Sinus bradycardia, early repolarization, isolated voltage criteria for LVH, incomplete RBBB

Q: What ECG findings require further evaluation?
A: T-wave inversions, pathologic Q waves, ST depression, prolonged QTc, epsilon waves, ventricular pre-excitation

Q: What QTc warrants further evaluation?
A: >470 ms males, >480 ms females

Q: Can athletes with LQTS participate in competitive sports?
A: 2025 guidelines: Shared decision-making allowed after risk counseling, beta-blocker therapy, AED access

Q: What is the recommendation for athletes with HCM?
A: 2025: Shared decision-making for lower-risk patients; certain high-risk features warrant restriction

Q: Can athletes with WPW participate in sports?
A: May participate after risk stratification; ablation recommended for high-risk pathway

Q: What is the return-to-play timeline after myocarditis?
A: Minimum 3-6 months; requires normal echo, Holter, exercise test, +/- CMR

Q: Can an athlete with AAORCA and negative stress test participate?
A: Yes - may participate with shared decision-making (Class IIa per 2025 guidelines)

Q: What is the recommendation for AAOLCA?
A: Restrict from competitive sports until surgical repair and clearance

Q: What testing is typically needed before return to sports after cardiac condition?
A: Echo (normal function), stress test (no ischemia/arrhythmia), Holter (no significant arrhythmia)

Q: What is the minimum restriction period after COVID-19 with cardiac involvement?
A: 3-6 months depending on severity of involvement

Q: What is the role of shared decision-making in sports cardiology?
A: Allows participation in some conditions after full risk counseling, acknowledging athlete autonomy