Course

PCMA

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11 Lessons

Before players start participating in any sport, they should be medically examined to ensure that they are sufficiently healthy to cope with the demands of training and playing. Therefore, medical assessments aimed at risk factor and disease detection are generally advocated by physicians and sports organisations. The aims of the pre-competition assessment are to prevent harm and to identify potentially significant medical conditions that might make playing football dangerous. A very small number of individuals have unknown or undiagnosed heart conditions, such as congenital cardiomyopathy, and may be at risk as exercise might trigger the manifestation of their disease or at least of associated symptoms like cardiac arrhythmia and might, in the worst case, cause sudden cardiac death. This small part of the population should be identified in order not to expose a player to any disproportionate risk.

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Learning outcomes

By the end of this course you should:

  • have an understanding of the value and limitations of the PCMA;
  • be able to complete the FIFA PCMA by taking an appropriate history, conducting a clinical examination and arranging appropriate investigations;
  • have an understanding regarding the indications and interpretation of echocardiogram (ECG) and ECG screening;
  • understand the changes relating to the ‘athlete’s heart’.

Tasks

  • Review the provided text and media content.
  • Read Chapter One of the FIFA Medical Manual, review the FIFA PCMA forms and consider reading the other suggested articles.
  • Complete the case-based assessment task.

Required Reading

F-MARC

Football Medicine Manual 2nd Edition

Chapter 2.1 (pages 24-61)

Suggested Reading

Brukner and Khan’s

Clinical Sports Medicine 4th Edition

Chapters 61 (pages 1176-1184) and 62 (pages 1185-1202)

References

  1. Dvořák, J., Grimm, K., Schmied, C., Junge, A. Development and implementation of a standardized precompetition medical assessment of international elite football players–2006 FIFA world cup germany. Clin J Sport Med. 2009;19(4):316-321.
  2. Thünenkötter, T., Schmied, C., Grimm, K., Dvořák, J., Kindermann, W. Precompetition cardiac assessment of football players participating in the 2006 FIFA world cup germany. Clin J Sport Med. 2009;19(4):322-325.
  3. Junge, A., Grimm, K., Feddermann, N., Dvořák, J. Precompetition orthopedic assessment of international elite football players. Clin J Sport Med. 2009;19(4):326-328.
  4. Dvořák. J., Grimm, K., Schmied, C., Junge, A. Feasibility of precompetition medical assessment at FIFA world cups for female youth players. Br J Sports Med. 2012;46(16):1132-1133.
  5. Schmied, C., Zerguini, Y., Junge, A., et al. Cardiac findings in the precompetition medical assessment of football players participating in the 2009 african under-17 championships in algeria. Br J Sports Med. 2009;43(9):716-721.
  6. Goldberg, B., Saraniti, A., Witman, P., Gavin, M., Nicholas, J.A. Pre-participation sports assessment–an objective evaluation. Pediatrics. 1980;66(5):736-745.
  7. Bille, K., Figueiras, D., Schamasch, P., et al. Sudden cardiac death in athletes: The Lausanne recommendations. Eur J Cardiovasc Prev Rehabil. 2006;13(6):859-875.
  8. Scharhag, J., Meyer, T. Return to play after acute infectious disease in football players. J Sports Sci. 2014;32(13):1237-1242.
  9. Meister, S., Faude, O., Ammann, T., Schnittker, R., Meyer, T. Indicators for high physical strain and overload in elite football players. Scand J Med Sci Sports. 2013;23(2):156-163.
  10. Meyer, T., Meister, S. Routine blood parameters in elite soccer players. Int J Sports Med. 2011;32(11):875-881.
  11. Chatard, J.C., Mujika, I., Guy, C., Lacour, J.R. Anaemia and iron deficiency in athletes. practical recommendations for treatment. Sports Med. 1999;27(4):229-240.
  12. Fallon, K.E. Screening for haematological and iron-related abnormalities in elite athletes-analysis of 576 cases. J Sci Med Sport. 2008;11(3):329-336.
  13. Baggish, A.L. A decade of athlete ECG criteria: Where we’ve come and where we’re going. J Electrocardiol. 2015;48(3):324-328.
  14. Corrado, D., Basso, C., Schiavon, M., Pelliccia, A., Thiene, G. Pre-participation screening of young competitive athletes for prevention of sudden cardiac death. J Am Coll Cardiol. 2008;52(24):1981-1989.
  15. Bohm, P., Ditzel, R., Ditzel, H., Urhausen, A., Meyer, T. Resting ECG findings in elite football players. J Sports Sci. 2013;31(13):1475-1480.
  16. Drezner, J.A., Ackerman, M.J., Anderson, J., et al. Electrocardiographic interpretation in athletes: The ‘seattle criteria’. Br J Sports Med. 2013;47(3):122-124.
  17. Drezner, J.A. Standardised criteria for ECG interpretation in athletes: A practical tool. Br J Sports Med. 2012;46 Suppl 1:i6-8.
  18. Exeter, D.J., Elley, C.R., Fulcher, M.L., Lee, A.C., Drezner, J.A., Asif, I.M. Standardised criteria improve accuracy of ECG interpretation in competitive athletes: A randomised controlled trial. Br J Sports Med. 2014;48(15):1167-1171.
  19. Schmied, C., Di Paolo, F.M., Zerguini, A.Y., Dvořák, J., Pelliccia, A. Screening athletes for cardiovascular disease in africa: A challenging experience. Br J Sports Med. 2013;47(9):579-584.
  20. Wilson, M.G., Sharma, S., Carre, F., et al. Significance of deep T-wave inversions in asymptomatic athletes with normal cardiovascular examinations: Practical solutions for managing the diagnostic conundrum. Br J Sports Med. 2012;46 Suppl 1:i51-8.
  21. Chandra, N., Bastiaenen, R., Papadakis, M., Sharma, S. Sudden cardiac death in young athletes: Practical challenges and diagnostic dilemmas. J Am Coll Cardiol. 2013;61(10):1027-1040.
  22. Pelliccia, A., Maron, M.S., Maron, B.J. Assessment of left ventricular hypertrophy in a trained athlete: Differential diagnosis of physiologic athlete’s heart from pathologic hypertrophy. Prog Cardiovasc Dis. 2012;54(5):387-396.
  23. Chandra, N., Papadakis, M., Sharma, S. Cardiac adaptation in athletes of black ethnicity: Differentiating pathology from physiology. Heart. 2012;98(16):1194-1200.
  24. Di Paolo, F.M., Schmied, C., Zerguini, Y.A., et al. The athlete’s heart in adolescent africans: An electrocardiographic and echocardiographic study. J Am Coll Cardiol. 2012;59(11):1029-1036.
  25. Stout, M. The marfan syndrome: Implications for athletes and their echocardiographic assessment. Echocardiography. 2009;26(9):1075-1081.
  26. Anderson, L., Exeter, D., Bowyer, L. Sudden cardiac death: Mandatory exclusion of athletes at risk is a step too far. Br J Sports Med. 2012;46(5):331-334.
  27. Oliveira, L.P., Lawless, C.E. Making prudent recommendations for return-to-play in adult athletes with cardiac conditions. Curr Sports Med Rep. 2011;10(2):65-77.
  28. Kramer, E.B., Dvořák, J., Schmied, C., Meyer, T. F-MARC: Promoting the prevention and management of sudden cardiac arrest in football. Br J Sports Med. 2015;49(9):597-598.