NU552 Unit 8 Module 4 Journal

Student Name

Purdue University Globle 

NU552 Advanced Health Assessment and Diagnostic Reasoning

Prof. Name

Date

Unit 8/Module 4 Journal: Comprehensive Sports Physical Examination and Cardiovascular Assessment

A comprehensive sports physical examination confirmed that the patient demonstrated normal findings across nearly all body systems, indicating medical fitness for physical activity. However, clinicians should remain vigilant for abnormal cardiac findings during pre-participation evaluations. A systolic murmur that becomes louder when standing is a potential warning sign for hypertrophic cardiomyopathy (HCM), a leading cause of sudden cardiac death in young athletes. Such findings require prompt cardiology evaluation and echocardiography before an athlete is medically cleared for competitive sports.

Patient Information

Verbal Consent

The student obtained and documented verbal consent from the adult volunteer before completing the examination and recording the assessment.

Head-to-Toe Physical Examination Findings

Head

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

Eyes

Ocular assessment demonstrated clear conjunctivae and non-icteric sclerae. There was no proptosis, and extraocular movements were intact. Pupils were equal, round, and reactive to light and accommodation (PERRLA). Peripheral vision remained grossly intact.

Ears

Gross hearing was normal bilaterally. External auditory canals were free of obstruction, and tympanic membranes appeared pearly gray with clearly visible landmarks. No erythema, bulging, or discharge was observed.

Nose

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

Throat and Oral Cavity

Oral examination revealed good dentition without obvious dental caries. Oral mucosa was moist and free of lesions. Tonsils were normal in size without erythema or exudate, and the tongue remained midline.

Neck

The neck exhibited full range of motion without discomfort. No cervical lymphadenopathy, thyroid enlargement, carotid bruits, tenderness, or palpable masses were detected. Speech and voice quality were normal.

Cardiopulmonary Assessment

Thorax and Lungs

The thorax was symmetrical with normal respiratory expansion. Lung auscultation revealed clear breath sounds bilaterally without wheezes, crackles, or rhonchi.

Heart

Cardiac examination demonstrated 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.

Lymphatic Assessment

No cervical or axillary lymphadenopathy was identified during examination.

Abdominal Assessment

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

Genitourinary Assessment

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

Musculoskeletal Assessment

Upper Extremities

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

Lower Extremities

Hips, knees, ankles, and feet exhibited full range of motion without pain or instability. Muscle strength remained 5/5 throughout both lower extremities. No edema, deformity, tenderness, bruising, or muscular atrophy was identified. Peripheral pulses were normal, and gait assessment demonstrated normal ambulation.

Back

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

Functional Movement Testing

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

• Single-leg squat

• Duck walk

• Hop test

• Heel-to-toe walking

No pain, instability, or movement limitations were observed during testing.

Neurological Assessment

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 measured 2+, and sensation to light touch remained intact. Balance and gait were normal.

Skin Assessment

Skin examination demonstrated warm, dry, intact skin without rashes, abrasions, suspicious lesions, infections, or signs of trauma.

Mental Status Examination

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

Peripheral Vascular Assessment

Peripheral vascular examination demonstrated normal circulation throughout all extremities.

Key findings included:

• Femoral pulses 2+ bilaterally without bruits

• Popliteal pulses 2+ and symmetric

• Posterior tibial pulses 2+ bilaterally

• Dorsalis pedis pulses 2+ bilaterally

• Warm, well-perfused extremities

• No cyanosis, pallor, or mottling

• Skin color appropriate for ethnicity

• No 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

Overall examination findings indicate a healthy adolescent male with normal cardiovascular, respiratory, neurological, musculoskeletal, and peripheral vascular function. No abnormalities were identified that would restrict participation in routine physical activity based on this examination.

However, clinicians should recognize that certain cardiac findings identified during sports physicals may indicate serious underlying disease even when the remainder of the examination appears normal.

Cardiac Murmur Evaluation During Sports Physicals

A loud systolic murmur auscultated along the left lower sternal border that becomes louder when the athlete stands warrants immediate clinical attention. Murmurs that increase in intensity with standing are characteristic of hypertrophic cardiomyopathy (HCM), a genetic disorder associated with left ventricular hypertrophy and sudden cardiac death in young athletes.

Clinical judgment should focus on evaluating:

• Murmur timing (systolic versus diastolic)

• Location and radiation

• Intensity

• Response to positional changes

• Associated symptoms

• Family history of cardiac disease or sudden death

Distinguishing an innocent murmur from hypertrophic cardiomyopathy requires careful diagnostic reasoning because HCM often remains asymptomatic until strenuous exercise provokes serious cardiovascular complications.

Diagnostic Reasoning

If an adolescent athlete presents with a systolic murmur that becomes louder upon standing, clinicians should evaluate for additional warning signs, including:

• Chest pain during exercise

• Syncope or near-syncope

• Palpitations

• Dyspnea on exertion

• Family history of sudden cardiac death

• Previous unexplained collapse during sports

The presence of any of these findings substantially increases concern for structural heart disease.

Recommended Management

Athletes with suspicious cardiac findings should not receive immediate sports clearance.

Recommended next steps include:

• Immediate referral to a cardiologist

• Transthoracic echocardiography

• Electrocardiogram (ECG) when clinically indicated

• Temporary restriction from competitive sports until cardiac disease is excluded

Early recognition and evaluation significantly reduce the risk of exercise-related cardiac events and improve athlete safety.

Key Clinical Takeaways

• A normal sports physical includes comprehensive cardiovascular, neurological, musculoskeletal, respiratory, and vascular assessment.

• Position-dependent systolic murmurs require further investigation.

• Hypertrophic cardiomyopathy remains one of the leading causes of sudden cardiac death among adolescent athletes.

• Echocardiography is the diagnostic test of choice when HCM is suspected.

• Athletes should not be cleared for competitive participation until serious cardiovascular disease has been excluded.

Quick Answers

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

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

Why is hypertrophic cardiomyopathy important during sports physicals?

Hypertrophic cardiomyopathy is a major cause of sudden cardiac death in young athletes and may initially present only as an abnormal heart murmur during routine pre-participation screening.

When should an athlete be referred to cardiology?

Referral is recommended when abnormal heart murmurs, exercise-related chest pain, fainting, abnormal ECG findings, or a family history of sudden cardiac death are present.

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 murmur that is loud, systolic, changes with body position, or is accompanied by symptoms such as chest pain or syncope requires additional cardiac evaluation.

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

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

What test confirms hypertrophic cardiomyopathy?

Transthoracic echocardiography is the primary imaging study used to diagnose hypertrophic cardiomyopathy. Additional testing, including electrocardiography and cardiac MRI, may be recommended based on clinical findings.

Why are positional changes important when evaluating heart murmurs?

Changes in murmur intensity with standing or Valsalva maneuvers help clinicians differentiate innocent murmurs from structural cardiac 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

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