NU552 Unit 8 Module 4 Journal

NU552 Unit 8 Module 4 Journal

Sports physical examinations help determine whether an athlete is medically safe to participate in physical activity by evaluating the cardiovascular, respiratory, neurological, musculoskeletal, and other body systems. In this assessment, the patient demonstrated normal findings throughout the examination and was medically fit for routine physical activity. However, healthcare providers must remain alert for abnormal cardiac findings during pre-participation evaluations. A systolic murmur that becomes louder when standing is a significant clinical finding that may indicate hypertrophic cardiomyopathy (HCM), one of the leading causes of sudden cardiac death in adolescent and young adult athletes. When this finding is present, immediate cardiology referral and echocardiography are recommended before sports clearance is granted.

Unit 8/Module 4 Journal: 

A comprehensive sports physical examination was performed to evaluate the patient’s overall health and determine fitness for athletic participation. The assessment included a complete head-to-toe examination, functional movement testing, cardiovascular screening, neurological assessment, and evaluation of the musculoskeletal and peripheral vascular systems.

Although the examination findings were normal, clinicians should always assess for warning signs of underlying cardiovascular disease because some life-threatening conditions may present with few or no symptoms.

Patient Information

Verbal Consent

Verbal consent was obtained from the adult volunteer before beginning the examination. Consent was documented according to clinical and educational requirements before completing the physical assessment.

Head-to-Toe Physical Examination

Head

The scalp and hair appeared healthy without evidence of trauma, masses, lesions, or other abnormalities.

Eyes

The conjunctivae were clear, and the sclerae were non-icteric. Extraocular movements were intact, and pupils were equal, round, and reactive to light and accommodation (PERRLA). Peripheral vision was grossly intact, and no proptosis was observed.

Ears

Hearing was grossly intact bilaterally. The external auditory canals were clear, and the tympanic membranes appeared pearly gray with normal landmarks. No erythema, bulging, or drainage was present.

Nose

The nasal septum remained midline with pink, moist mucosa. There was no turbinate enlargement, nasal drainage, or sinus tenderness.

Throat and Oral Cavity

The patient demonstrated good oral hygiene with healthy dentition and no visible dental caries. The oral mucosa was moist without lesions. Tonsils were normal in size and free of erythema or exudate, and the tongue remained midline.

Neck

The neck demonstrated full range of motion without pain or stiffness. There was no cervical lymphadenopathy, thyroid enlargement, carotid bruit, tenderness, or palpable mass. Speech and voice quality were normal.

Cardiopulmonary Assessment

Thorax and Lungs

The thorax was symmetrical with normal respiratory expansion. Breath sounds were clear bilaterally without wheezes, crackles, or rhonchi.

Heart

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, gallops, rubs, or thrills. No murmur was detected during the Valsalva maneuver.

Lymphatic Assessment

No cervical or axillary lymphadenopathy was identified.

Abdominal Assessment

The abdomen was soft, non-distended, and non-tender. Bowel sounds were normal, and no hepatosplenomegaly, abdominal masses, hernias, or surgical scars were noted.

Genitourinary Assessment

Examination of the external male genitalia demonstrated bilaterally descended testes without tenderness or palpable masses. No scrotal swelling, lesions, discharge, or inguinal hernia was identified during the Valsalva maneuver.

Musculoskeletal Assessment

Upper Extremities

The shoulders, elbows, wrists, and fingers demonstrated full range of motion with normal joint stability. Muscle strength measured 5/5 bilaterally. No swelling, tenderness, bruising, deformities, edema, or clubbing was observed. Peripheral pulses were graded 2+ bilaterally.

Lower Extremities

The hips, knees, ankles, and feet demonstrated full range of motion without pain or instability. Muscle strength remained 5/5 throughout both lower extremities. No edema, deformity, tenderness, bruising, or muscle atrophy was present. Peripheral pulses were normal, and gait was steady.

Back

Spinal alignment was midline with normal physiologic curvature. Flexion, extension, lateral bending, and rotational movements were unrestricted and pain-free. No scoliosis, tenderness, deformity, or paraspinal muscle spasm was identified.

Functional Movement Testing

Functional orthopedic testing demonstrated excellent balance, coordination, flexibility, and lower-extremity strength. The patient successfully completed:

• Single-leg squat

• Duck walk

• Hop test

• Heel-to-toe walking

No pain, instability, weakness, or movement limitations were observed.

Neurological Assessment

The patient was alert and oriented with intact cranial nerves II through XII. Motor strength was 5/5 in all extremities, deep tendon reflexes were graded 2+, sensation to light touch remained intact, and balance and gait were normal.

Skin Assessment

The skin was warm, dry, and intact without rashes, abrasions, infections, suspicious lesions, or evidence of trauma.

Mental Status Examination

The patient appeared cooperative with an appropriate mood and affect. Speech was clear and coherent, thought processes were logical, and there were no signs of anxiety, depression, agitation, hostility, or cognitive impairment.

Peripheral Vascular Assessment

Peripheral vascular examination demonstrated normal circulation throughout all extremities.

Assessment findings included:

• Femoral pulses 2+ bilaterally without bruits

• Popliteal pulses 2+ and symmetrical

• Posterior tibial pulses 2+ bilaterally

• Dorsalis pedis pulses 2+ bilaterally

• Warm, well-perfused extremities

• Normal skin color appropriate for ethnicity

• No cyanosis, pallor, mottling, or pulse deficits

Capillary Refill

Capillary refill time measured less than two seconds in both the upper and lower extremities, indicating adequate peripheral perfusion.

Clinical Interpretation

The overall examination demonstrated a healthy adolescent male with normal cardiovascular, respiratory, neurological, musculoskeletal, abdominal, and peripheral vascular findings. Based on this assessment, no abnormalities were identified that would limit participation in routine physical activity.

Despite a normal examination, clinicians should remember that certain cardiovascular abnormalities identified during sports physicals may indicate serious underlying disease and require immediate evaluation before athletic participation.

Cardiac Murmur Evaluation During Sports Physicals

One of the most important components of a pre-participation physical examination is careful cardiac auscultation. A systolic murmur heard along the left lower sternal border that becomes louder when the athlete stands is particularly concerning because it is characteristic of hypertrophic cardiomyopathy (HCM).

HCM is an inherited disorder characterized by abnormal thickening of the left ventricular myocardium. It is a leading cause of sudden cardiac death among young athletes, particularly during strenuous physical activity.

Healthcare providers should evaluate the following murmur characteristics:

• Timing (systolic or diastolic)

• Location

• Radiation

• Intensity

• Response to standing or the Valsalva maneuver

• Associated symptoms

• Family history of cardiovascular disease or sudden cardiac death

Differentiating an innocent murmur from HCM requires careful clinical assessment because many affected athletes remain asymptomatic until exercise triggers serious cardiovascular complications.

Diagnostic Reasoning

When a systolic murmur becomes louder with standing, clinicians should assess for additional warning signs that increase the likelihood of structural heart disease, including:

• Chest pain during exercise

• Syncope or near-syncope

• Palpitations

• Dyspnea on exertion

• Family history of sudden cardiac death

• Previous unexplained collapse during athletic activity

The presence of one or more of these findings warrants prompt cardiovascular evaluation.

Recommended Management

Athletes with suspicious cardiac findings should not be cleared for competitive sports until a complete cardiac evaluation has been performed.

Recommended management includes:

• Immediate referral to a cardiologist

• Transthoracic echocardiography

• Electrocardiogram (ECG) when clinically indicated

• Temporary restriction from competitive sports until structural heart disease has been excluded

Early diagnosis and appropriate management substantially reduce the risk of exercise-related cardiac events and improve athlete safety.

Key Clinical Takeaways

• A comprehensive sports physical evaluates cardiovascular, respiratory, neurological, musculoskeletal, and peripheral vascular health.

• Position-dependent systolic murmurs require additional diagnostic evaluation.

• Hypertrophic cardiomyopathy remains one of the leading causes of sudden cardiac death in adolescent and young adult athletes.

• Transthoracic echocardiography is the preferred diagnostic imaging study when HCM is suspected.

• Athletes should not participate in competitive sports until significant cardiovascular disease has been ruled out.

Quick Answers

What does a systolic murmur that becomes louder when standing suggest?

A systolic murmur that increases in intensity with standing raises concern for hypertrophic cardiomyopathy and requires further cardiac evaluation before sports participation is approved.

Why is hypertrophic cardiomyopathy important during sports physicals?

Hypertrophic cardiomyopathy is one of the leading causes of sudden cardiac death in young athletes and may first be detected as an abnormal heart murmur during a routine pre-participation examination.

When should an athlete be referred to cardiology?

Referral is recommended when an athlete has an abnormal heart murmur, exercise-induced chest pain, syncope, abnormal ECG findings, palpitations, or a family history of sudden cardiac death.

Frequently Asked Questions

What is the purpose of a sports physical examination?

A sports physical evaluates an athlete’s overall health and identifies medical conditions that could increase the risk of injury or serious complications during athletic participation.

What makes a heart murmur concerning in adolescent athletes?

A loud systolic murmur, a murmur that changes with body position, or a murmur associated with symptoms such as chest pain, syncope, or palpitations requires further cardiac evaluation.

Can an athlete participate in sports while waiting for cardiac evaluation?

No. Athletes with suspected structural heart disease should be temporarily restricted from competitive sports until a cardiologist determines that participation is safe.

What test confirms hypertrophic cardiomyopathy?

Transthoracic echocardiography is the primary diagnostic imaging test for hypertrophic cardiomyopathy. Additional testing, including electrocardiography (ECG) and cardiac magnetic resonance imaging (MRI), may also be indicated.

Why are positional changes important when evaluating heart murmurs?

Changes in murmur intensity during standing or the Valsalva maneuver help clinicians distinguish innocent heart murmurs from structural abnormalities such as hypertrophic cardiomyopathy.

References

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

NU552 Unit 8 Module 4 Journal

Kim, J.-H., Baggish, A. L., Levine, B. D., Ackerman, M. J., Day, S. M., Dineen, E. H., … American Heart Association, & American College of Cardiology. (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