Name
Purdue University Globle
NU552 Advanced Health Assessment Course Module Overview
Prof. Name
Date
A comprehensive sports physical examination helps determine whether an athlete can safely participate in physical activity while identifying conditions that may require additional evaluation. In this assessment, the patient demonstrated normal findings across the major body systems, including the cardiovascular, respiratory, neurological, musculoskeletal, abdominal, and peripheral vascular systems. Although the examination was generally normal, clinicians must pay particular attention to abnormal cardiac findings during pre-participation evaluations. A systolic murmur that becomes louder when standing is an important finding because it can suggest hypertrophic cardiomyopathy (HCM), a structural heart condition associated with sudden cardiac events in young athletes. When a concerning murmur or related symptoms are identified, the athlete should undergo appropriate cardiac evaluation before being cleared for competitive sports.
| Assessment Finding | Result |
|---|---|
| Sex | Male |
| Height | 5 ft 10 in |
| Weight | 190 lb |
| Temperature | 98°F |
| Pulse | 70 beats/min |
| Respiratory rate | 15 breaths/min |
| Blood pressure | 110/70 mmHg |
Before beginning the physical examination, the student obtained and documented verbal consent from the adult volunteer. Consent was obtained before performing the assessment and recording the examination findings.
The scalp and hair appeared healthy and intact. No evidence of trauma, masses, lesions, or other visible abnormalities was identified.
The conjunctivae were clear, and the sclerae were non-icteric. No proptosis was present. Extraocular movements were intact, and pupils were equal, round, and reactive to light and accommodation (PERRLA). Peripheral vision was grossly intact.
Gross hearing was intact bilaterally. The external auditory canals were unobstructed, and the tympanic membranes appeared pearly gray with visible anatomical landmarks. There was no erythema, bulging, drainage, or other abnormal finding.
The nasal septum was midline, and the nasal mucosa was pink and moist. No turbinate enlargement, abnormal drainage, or sinus tenderness was noted.
The oral examination showed good dentition without obvious dental caries. The oral mucosa was moist and free of visible lesions. The tonsils were normal in size without erythema or exudate. The tongue was midline.
The neck had a full, painless range of motion. No cervical lymphadenopathy, thyroid enlargement, carotid bruits, tenderness, or palpable masses were detected. Speech and voice quality were normal.
The thorax was symmetrical, with normal respiratory expansion. Auscultation revealed clear bilateral breath sounds without wheezes, crackles, or rhonchi.
Cardiac examination revealed a nondisplaced point of maximal impulse (PMI) with a regular rate and rhythm. Normal S1 and S2 heart sounds were present without murmurs, rubs, gallops, or thrills. No murmur was appreciated during the Valsalva maneuver.
No enlarged cervical or axillary lymph nodes were identified during the examination.
The abdomen was soft, nondistended, and nontender. Bowel sounds were normal. No hepatosplenomegaly, palpable masses, hernias, or surgical scars were observed.
The external male genitalia appeared normal. Both testes were descended without tenderness or palpable masses. No scrotal swelling, lesions, discharge, or inguinal hernia was identified during the Valsalva maneuver.
The shoulders, elbows, wrists, and fingers demonstrated full range of motion and normal joint stability. Muscle strength was 5/5 bilaterally. There was no swelling, tenderness, deformity, bruising, edema, or clubbing. Peripheral pulses were 2+ bilaterally.
The hips, knees, ankles, and feet demonstrated full range of motion without pain or instability. Muscle strength was 5/5 bilaterally. No edema, deformity, tenderness, bruising, or muscular atrophy was noted. Peripheral pulses were normal, and gait was steady and coordinated.
The spine was aligned at midline with normal physiologic curvature. Flexion, extension, lateral bending, and rotation were full and painless. There was no spinal tenderness, scoliosis, deformity, or paraspinal muscle spasm.
Functional orthopedic testing demonstrated good balance, coordination, strength, and movement control. The patient successfully completed single-leg squats, duck walking, hopping, and heel-to-toe walking without pain, instability, or limitation.
The patient was alert and fully oriented. Cranial nerves II through XII were intact. Motor strength was 5/5 in all extremities, deep tendon reflexes were 2+, and sensation to light touch was intact. Balance and gait were normal.
The skin was warm, dry, and intact. No rash, abrasion, suspicious lesion, infection, or evidence of trauma was observed.
The patient was cooperative and displayed an appropriate mood and affect. Speech was clear and coherent, and thought processes were logical. No apparent cognitive impairment, agitation, hostility, or other behavioral abnormality was noted during the assessment.
Peripheral circulation was normal throughout all four extremities. Femoral, popliteal, posterior tibial, and dorsalis pedis pulses were 2+ and symmetric. The extremities were warm and well perfused, with no cyanosis, pallor, mottling, or detectable pulse deficits.
Capillary refill was less than two seconds in both the upper and lower extremities, supporting adequate peripheral tissue perfusion.
Overall, the examination findings were consistent with a healthy adolescent male with normal cardiovascular, respiratory, neurological, musculoskeletal, abdominal, and peripheral vascular function. No abnormal findings were identified during this examination that would independently indicate a restriction from routine physical activity.
However, a normal physical examination does not eliminate the possibility of underlying cardiovascular disease. Pre-participation sports evaluations should include careful assessment of personal symptoms, family history, cardiac auscultation, and other findings that may indicate increased cardiovascular risk.
Heart murmurs are an important component of cardiovascular assessment in athletes. The clinician should characterize a murmur according to its timing, location, intensity, radiation, and response to maneuvers or changes in body position.
A systolic murmur that becomes louder when an athlete stands is particularly important because decreased venous return can increase the intensity of the murmur associated with hypertrophic cardiomyopathy. This finding should prompt further assessment rather than immediate sports clearance.
Clinicians should consider several characteristics when evaluating a potentially abnormal murmur:
Whether the murmur occurs during systole or diastole
Where the murmur is best heard
Whether it radiates to another location
Its intensity and quality
Whether its intensity changes with standing or other maneuvers
Whether cardiovascular symptoms are present
Whether there is a personal or family history of cardiac disease or sudden death
Hypertrophic cardiomyopathy is a genetic cardiac disorder characterized by abnormal thickening of the heart muscle, particularly the left ventricle. The condition can interfere with normal cardiac filling and, in some patients, contribute to left ventricular outflow obstruction and dangerous arrhythmias.
HCM is clinically important in sports medicine because some affected individuals have few or no symptoms before a serious cardiovascular event occurs. A previously healthy athlete may therefore require additional evaluation when a suspicious murmur or relevant history is identified.
A concerning murmur should be evaluated in the context of the athlete’s symptoms and medical history. Important warning signs include:
Chest pain or pressure associated with exercise
Syncope or near-syncope, particularly during exertion
Unexplained shortness of breath with exercise
Palpitations
Unexplained seizures or collapse
A personal history of unexplained exercise intolerance
A family history of premature sudden cardiac death or inherited cardiac disease
These findings do not establish a diagnosis of HCM by themselves, but they increase the need for appropriate cardiovascular assessment.
When the history or physical examination raises concern for structural heart disease, the athlete should receive appropriate cardiovascular evaluation before returning to competitive sports.
Transthoracic echocardiography is a key diagnostic imaging study for evaluating suspected HCM because it can assess ventricular wall thickness, cardiac structure, ventricular function, and patterns of blood flow. An electrocardiogram (ECG) may also provide useful information about electrical abnormalities associated with cardiac disease. Depending on the clinical situation, a cardiologist may recommend additional testing, such as ambulatory rhythm monitoring, exercise testing, genetic evaluation, or cardiac magnetic resonance imaging.
An athlete with a suspicious cardiac finding should not be automatically cleared for competitive sports. The appropriate approach is to determine whether the finding represents a benign physiologic variation or an underlying cardiovascular disorder.
When HCM or another significant cardiac condition is suspected, management may include:
Referral to a qualified cardiologist
Comprehensive cardiovascular assessment
Transthoracic echocardiography
ECG when clinically appropriate
Additional cardiac testing based on specialist assessment
Temporary restriction from competitive sports when clinically indicated until significant cardiac disease has been evaluated
Sports participation decisions should be individualized and based on current clinical guidelines, the athlete’s diagnosis, symptoms, risk factors, and specialist assessment.
Sports physical examinations provide an opportunity to identify cardiovascular conditions that may not be apparent during routine healthcare visits. The cardiovascular component should therefore extend beyond simply recording blood pressure and heart rate.
A thorough assessment includes cardiac auscultation as well as questions about exertional symptoms and family history. Recognizing concerning findings early can lead to timely diagnostic evaluation and appropriate counseling about safe athletic participation.
A comprehensive sports physical evaluates multiple systems that influence an athlete’s ability to participate safely.
Cardiovascular assessment is an essential component of pre-participation screening.
A systolic murmur that changes significantly with standing requires careful evaluation.
Hypertrophic cardiomyopathy can be asymptomatic and may first become apparent during a sports physical.
Exercise-related syncope, chest pain, palpitations, or unexplained dyspnea should not be dismissed.
Echocardiography is an important diagnostic study when HCM is suspected.
Athletes with potentially serious cardiac abnormalities may require specialist evaluation before competitive sports clearance.
What does a systolic murmur that becomes louder when standing suggest?
A systolic murmur that becomes louder with standing can raise concern for hypertrophic cardiomyopathy because changes in venous return can alter the intensity of the murmur. The finding requires clinical assessment rather than being treated as diagnostic by itself.
Why is hypertrophic cardiomyopathy important during a sports physical?
Hypertrophic cardiomyopathy is important because it can remain undiagnosed in otherwise healthy young people and may be associated with serious arrhythmias and sudden cardiac events, particularly during strenuous activity.
When should an athlete be referred for cardiac evaluation?
Cardiac evaluation should be considered when an athlete has a concerning murmur, exertional syncope, exercise-related chest pain, unexplained dyspnea, palpitations, an abnormal cardiovascular history, or a family history suggestive of inherited cardiac disease or premature sudden cardiac death.
A sports physical, or pre-participation physical evaluation, assesses an athlete’s general health and identifies medical conditions that could affect safe participation in physical activity. It commonly includes cardiovascular, respiratory, neurological, musculoskeletal, and other relevant assessments.
A murmur may be concerning when it has characteristics associated with structural heart disease, including unusual intensity, concerning timing, abnormal location or radiation, or significant changes with positional or physiologic maneuvers. Symptoms and family history further influence the level of concern.
An athlete with a finding that raises significant concern for cardiovascular disease should be evaluated before being cleared for competitive participation. The decision to restrict activity depends on the clinical findings and the level of suspected risk.
Transthoracic echocardiography is a primary imaging test for evaluating suspected HCM. ECG and other studies may also be used depending on the patient’s history, physical findings, and specialist assessment.
Standing changes venous return and cardiac filling, which can alter the intensity of certain heart murmurs. Observing these changes can help clinicians distinguish different types of murmurs and identify findings that warrant additional evaluation.
Athletes should report symptoms such as exertional chest pain, unexplained fainting, near-fainting, unusual shortness of breath, palpitations, or unexplained exercise intolerance. A relevant family history of sudden cardiac death or inherited heart disease should also be communicated to the healthcare provider.
American Heart Association. (n.d.). Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Preamble, principles, and general considerations. https://professional.heart.org/en/guidelines-statements/eligibility-and-disqualification-recommendations-for-competitive-athletes-with-cardiovascular-abnormalities
Kim, J.-H., Baggish, A. L., Levine, B. D., Ackerman, M. J., Day, S. M., Dineen, E. H., et al. (2025). Clinical considerations for competitive sports participation for athletes with cardiovascular abnormalities: A scientific statement from the American Heart Association and American College of Cardiology. Journal of the American College of Cardiology, 85(10), 1059–1108. https://doi.org/10.1016/j.jacc.2024.12.025
Ommen, S. R., Mital, S., Burke, M. A., Day, S. M., Deswal, A., Elliott, P., et al. (2024). 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR guideline for the management of hypertrophic cardiomyopathy. Circulation, 149(23), e1239–e1311. https://doi.org/10.1161/CIR.0000000000001250
Maron, B. J., Levine, B. D., Washington, R. L., Baggish, A. L., Kovacs, R. J., & Maron, M. S. (2015). Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Task Force 2: Preparticipation screening for cardiovascular disease in competitive athletes. Journal of the American College of Cardiology, 66(21), 2356–2361. https://doi.org/10.1016/j.jacc.2015.09.034
