A 16-year-old male was seen for routine physical exam for sports participation clearance. States he feels well today and past medical history is non-contributory. Upon exam, all systems are within normal limits with the exception of a cardiovascular murmur, loudest over the apex, grade II/IV systolic. Patient denies current or previous cardiac symptoms. Denies family history of cardiovascular disease or sudden cardiac death.
The recommendation in this case should be to withhold sports clearance pending a thorough cardiovascular workup, to initially include electrocardiogram, chest x-ray, and potentially echocardiogram (with subsequent referral to cardiology) to help rule out cardiomyopathy (National Heart, ...