Preparticipation sports screening is an essential yet difficult tool used for athletic clearance. This purpose of the screening is to identify those at risk for sudden cardiac death and to enlist restrictions for those with known factors that predispose the athlete to sudden death. Despite its importance, the ability of this screening to identify those at risk varies and is questionable. The thoroughness and expertise of clinicians vary, and this factor understandably affects the screening process and overall findings. Only 3% of trained athletes who experienced sudden cardiac death were previously suspected of having a cardiovascular abnormality during the preparticipation sports exam. Thankfully, sudden cardiovascular death is a rare phenomenon, affecting 1 in 200,000 to 300,000 individual student athletes per academic year. The risk for sudden death in young athletes with cardiovascular disease is 2.5 times higher than in nonathletes. In the United States, sudden cardiac death most commonly occurs with basketball and football. Males account for 90% of the cases.

The medical history is the most important aspect of the cardiovascular PPE. It should focus on the presence of symptoms such as: near-syncope, syncope, dizziness, chest pain, chest tightness, and fatigue. Medication history, including questions regarding illicit and performance-enhancing drug use, is extremely important. The history should also elicit information concerning Kawasaki disease, rheumatic fever, myocarditis, arrhythmias, hypertension, congenital heart disease, and heart murmurs. A history of seizures or near-drowning may indicate long QT syndrome. Pertinent findings in the family history include: congenital heart disease, long QT syndrome, Marfan syndrome, and cardiomyopathy.