Sudden cardiac death (SCD) is the leading cause of death during exercise for athletes younger than 35 years. Structural cardiac abnormalities are responsible for the majority of SCDs among competitive athletes. The screening protocol that is best for detecting athletes at risk for SCD has been the subject of considerable and long-standing debate. The American Heart Association recommends the use of a 14-element history and physical examination (H&P), whereas European standards call for a focused H&P and 12-lead electrocardiogram (ECG). The use of ECG screening has been repeatedly rejected in the United States because of the high rate of false-positive results and an abundance of evidence suggesting that it is a cost-ineffective tool for screening. Attempts have also been made to prescreen athletes for cardiac disease with echocardiography (ECHO) performed by a cardiologist; however, this technique also proved to be cost-ineffective. The use of ECHO performed by a frontline physician reflects recent advancements in ultrasound technology utilization, including the advent of portable ultrasound, and introduces a new, promising screening method to the debate. Portable ECHO by a frontline physician (PEFP) has the ability to directly visualize structural components of the heart that are part of the gold standard ECHO evaluation performed by a cardiologist. The Early Screening for Cardiac Abnormalities with Preparticipation Echocardiography (ESCAPE) protocol developed at Northeastern University is the first attempt to implement the PEFP. Initial inquiries into the reliability and feasibility of the PEFP are promising. Measurements obtained by frontline physicians were not statistically different from those obtained by a cardiologist, focused ECHO was found to reduce the referral rate to cardiology by 33%, and PEFP was completed significantly faster than H&P and an ECG. Early results are encouraging, but continued research to support the widespread use of PEFP for preparticipation examination in all competitive athletes is needed prior to recommending implementation.

Incorporating limited PEFP into PPEs has the potential to limit the number of false-positive and false-negative cardiac screens. Limited PEFP was the fastest screening modality compared with traditional H&P and ECG methods. Based on the time-driven activity-based paradigm of cost analysis, limited PEFP as part of the PPE yields the highest value: the most accurate and reliable information and the lowest dollar/time expenditure.

The availability of handheld ultrasound offers physicians an opportunity to better define anatomy and pathophysiology, thus enhancing the diagnostic capabilities of a standard physical examination. The medical community increasingly embraces the potential for point-of-care ultrasound across medical specialties. The primary aim of this review was to identify and compile information on the current clinical utility of point-of-care ultrasound for musculoskeletal examination. This information will enable health care providers to understand the current utility and potential of musculoskeletal point-of-care ultrasound, thus facilitating its appropriate adoption into clinical practice.

Athletes' hearts have been studied for adaptive changes in response to exercise. Physiologic changes are normal responses to intense athletic training regimens, whereas pathologic changes predispose athletes to sudden cardiac death. The two alterations overlap in clinical presentation. Research continues to investigate the upper limits of cardiac remodeling to aid clinical decision making. Studying normal changes that occur in response to exercise will advance physicians' understanding of physiologic responses to exercise and potentially improve clinical distinction. To expand this body of knowledge, we present an observational case series that describes morphologic changes in athlete's hearts concurrent with performance measurements.

Sudden cardiac death (SCD) is the leading cause of death during exercise in young athletes. Preparticipation physical examinations were developed to maintain the health and safety of athletes, including the prompt identification of those at risk for SCD. The use of medical history and physical examinations, electrocardiography, and echocardiography, or some combination thereof, is the source of continued debate. This article provides an overview of the etiology of SCD and reviews literature relating to preparticipation echocardiography, with a focus on its evolution, utility, and effectiveness. The limited echocardiogram is a potentially viable screening option yet to be thoroughly explored by experts and policymakers in the sports medicine community.