PRE PARTICIPATION HEART CHECK (PPHC)

Pre-Participation Heart Check (PPHC)

Before signing up for a pre-participation screening program, here is some information you may need to know.  Pre-Participation Screening is aimed at reducing the risk of sudden deaths and injury during exercise.  There are 3 components (aims) to this pre-participation screening program and include:

  1. Pre-participation heart check (i.e. cardiovascular screening) to reduce the risk of sudden death
  2. Pre-participation muscular-skeletal screening to identify injuries that need to be managed to prevent aggravation or to identify factors that may predispose the participants to future injuries
  3. Identify factors that may limit performance, e.g. anemia or existing medications etc.
    (MOH Clinical Practice Guides – Screening for Cardiovascular Disease and Risk Factors – 2011).

Why and What is Pre-participation Heart Check?

Since sudden death is often related to underlying heart conditions the concept of pre-participation heart check appears sensible. Pre-participation heart check usually requires one or more stages of screening process.  One usually begins with stage one, (i.e. PYCC-PPHC I) which consists of a personal and family history-taking, a pre-participation cardiovascular screening questionnaire (recommended by the American Heart Association) and a physical examination by a cardiologist.  Biometric analysis (BMI), resting ECG and blood biochemistry are also done.  A cardiovascular risk score is then computed based on the above and depending on the risk score, further cardiac evaluation may be needed such as chest x-ray, exercise treadmill stress test, 2D Echo/Doppler study, CAC Score, etc.

Who should undergo Pre-participation Heart Check?

  1. An individual who may have intrinsic risk of sudden cardiac death (history of cardiac symptoms – exertional chest pain, exertional breathlessness, previous fainting episodes, etc, positive family history e.g. family history of premature coronary artery disease occurring in first degree relatives – male > 55 years old and female > 65 years old or family history of sudden death).
  2. Individuals with history of multiple cardiovascular risk factors including – high blood pressure, high cholesterol, high blood sugar levels, overweight/obesity, smoking, unhealthy diet, previously physically inactive.
  3. Males > 45 years old and female > 55 years old planning to start moderate to high intensity exercise.
  4. Diabetics ≥ 40 years old and planning to start moderate to high intensity exercise.

    Depending on the risk levels, individuals will be advised on evaluation and management. A heart check will:

    • Assess the level of competition (see figure 1 below) or the degree of cardiovascular activity (figure 2 below) based on the exercise or sport involved.

Source: MOH Clinical Practice Guides – Screening for Cardiovascular Disease and Risk Factors 1/ 2011
Figure 1.  Athletes’ competitive levels

  1. The degree of risk of the particular sport or activity (see figure 2 below).
Category
1 2
Sport Bowling

Bowls

Chess

Contract bridge

Cuesports

Darts

Gateball

Golf

Shooting

Sport boules

Weiqi

Woodball

Xiangqi

Archery

Badminton

Baseball/

Softball

Basketball

Bodybuilding

*Boxing/ wrestling (not an

NSA sport)

Canoeing

Cricket

Cycling

Dancesport

Dragonboat

Equestrian

Fencing

Field events

Floorball

Gymnastics

Hockey

Iceskating

Kayaking

Lifesaving

Martial arts

Motor sports

Mountaineering

Netball

Pickleball

Powerboat

Rollersports

Rowing

Running

Sailing

Sepak takraw

Soccer

Squash

Swimming

Table tennis

Tennis

Triathlon

Underwater activities

Volleyball

Waterski/     Wakeboard

Weightlifting

Source: Maron et al. 36th Bethesda Conference: Eligibility Recommendations for Competitive Athletes With Cardiovascular Abnormalities. 173
Figure 2.  Categorization of sports based on cardiovascular activity

  1. Other factors such as age. For example, a 55-year-old novice marathon runner may be zealously undergoing high-intensity, high-mileage training without building up to it and would be considered at risk of sudden death even though he may be doing casual runs or a weekend runner.
  2. Assessment of the duration and intensity of the sports participation e.g. endurance or ultra-endurance demands and environmental stress.

The recognition that pre-participation screening is only part of a strategy to decrease the chance of sudden death and adverse events occurring, education is the other crucial component of the overall strategy.  Individuals should be educated on symptoms and signs that require medical attention before embarking on sports activity or exercise and this will be given in pre-run advice.

Finally, to reiterate:- the purpose of pre-participation cardiovascular screening is to detect in the asymptomatic individual cardiovascular risks and disease with the view that early intervention will forestall the disease and complications respectively.

Also see article on Sudden Death and Sudden Cardiac Death.

PYCC
Pre-Participation Heart Check (PPHC)
PYCC PPHC I 
$250 + GST
  • Pre-participation cardiovascular screening questionnaire [recommended by American Heart Association (AHA)]
  • Cardiologist (heart specialist) consultation
  • Cardiovascular examination including :

    • BP and heart rate checks
    • Cardiac auscultation
  • Biometric analysis

    • height
    • weight
    • BMI
  • Resting ECG
  • Blood Biochemistry
    • Renal (Kidney) Profile
      • Potassium
      • Sodium
      • Chloride
      • Bicarbonate
      • Urea
      • Creatinine
      • eGFR (for ages 18 – 74)
    • Lipid Profile
      • Total cholesterol
      • LDL cholesterol
      • HDL cholesterol
      • Tryglycerides
      • Total cholesterol/HDL ratio
    • Liver Profile
      • Protein, Total
      • Albumin
      • Globulin
      • A/G Ratio
      • Bilirubin, Total\
      • Alkaline Phosphatase
      • Aspartate Aminotransferase (AST)
      • Alanine Aminotransferase (ALT)
      • Gamma-Glutamyltransferase (GGT)
    • Haematology Tests
      • Haemogram
        • Haemoglobin
        • Red Blood Cell Count
        • Packed Cell Volume (HCT)
        • Red Cell Indices (MCV, MCH, MCHC)
        • Red Cell Distribution Width (RDW)
        • Mean Platelet Volume (MPV)
        • Platelet Count
        • White Blood Cell Count
        • Differential Count
        • Peripheral Blood Film
    • Endocrine (Gland) Function
      • Glucose
      • Glycated Haemoglobin (HbA1c)
    • High-sensitivity C-reactive protein (hs-CRP) Test Haematology Tests
    • Urine Test
      • Urine Albumin / Creatinine Ratio
    • Bone/Joint Profile
      • Uric Acid
    • Thyroid Function Tests
      • Free Thyroxine (Free T4)
      • Thyroid Stimulating Hormone (TSH)
  • Cardiovascular risk assessment and score using risk engines
  • 2nd Consultation with heart specialist and discussion of results
  • Pre-run advice
PYCC
Pre-Participation Heart Check (PPHC)
PYCC PPHC II 
$395 + GST
  • Pre-participation cardiovascular screening questionaire [recommended by American Heart Association (AHA)]
  • Cardiologist (heart specialist) consultation
  • Cardiovascular examination including :

    • BP and heart rate checks
    • Cardiac auscultation
  • Biometric analysis
    • height
    • weight
    • BMI
  • ADDITIONAL
    • Chest x-ray
    • Treadmill exercise stress test (supervised and reported by cardiologist)
  • Resting ECG
  • Blood Biochemistry
    • Renal (Kidney) Profile
      • Potassium
      • Sodium
      • Chloride
      • Bicarbonate
      • Urea
      • Creatinine
      • eGFR (for ages 18 – 74)
    • Lipid Profile
      • Total cholesterol
      • LDL cholesterol
      • HDL cholesterol
      • Tryglycerides
      • Total cholesterol/HDL ratio
    • Liver Profile
      • Protein, Total
      • Albumin
      • Globulin
      • A/G Ratio
      • Bilirubin, Total\
      • Alkaline Phosphatase
      • Aspartate Aminotransferase (AST)
      • Alanine Aminotransferase (ALT)
      • Gamma-Glutamyltransferase (GGT)
    • Haematology Tests
      • Haemogram
        • Haemoglobin
        • Red Blood Cell Count
        • Packed Cell Volume (HCT)
        • Red Cell Indices (MCV, MCH, MCHC)
        • Red Cell Distribution Width (RDW)
        • Mean Platelet Volume (MPV)
        • Platelet Count
        • White Blood Cell Count
        • Differential Count
        • Peripheral Blood Film
    • Endocrine (Gland) Function
      • Glucose
      • Glycated Haemoglobin (HbA1c)
    • High-sensitivity C-reactive protein (hs-CRP) Test Haematology Tests
    • Urine Test
      • Urine Albumin / Creatinine Ratio
    • Bone/Joint Profile
      • Uric Acid
    • Thyroid Function Tests
      • Free Thyroxine (Free T4)
      • Thyroid Stimulating Hormone (TSH)
  • Cardiovascular risk assessment and score using risk engines
  • 2nd Consultation with heart specialist and discussion of results
  • Pre-run advice
PYCC
Pre-Participation Heart Check (PPHC)
PYCC PPHC III 
$890 + GST
  • Pre-participation cardiovascular screening questionaire [recommended by American Heart Association (AHA)]
  • Cardiologist (heart specialist) consultation
  • Cardiovascular examination including :

    • BP and heart rate checks
    • Cardiac auscultation
  • Biometric analysis
    • height
    • weight
    • BMI
  • ADDITIONAL
    • 2 Dimensional Echocardiography/ Doppler Study
    • Coronary Calcium Score (CAC Score)
  • Cardiac Investigation
    • Resting ECG
    • Chest x-ray
    • Treadmill exercise stress test (supervised and reported by cardiologist)
  • Blood Biochemistry
    • Renal (Kidney) Profile
      • Potassium
      • Sodium
      • Chloride
      • Bicarbonate
      • Urea
      • Creatinine
      • eGFR (for ages 18 – 74)
    • Lipid Profile
      • Total cholesterol
      • LDL cholesterol
      • HDL cholesterol
      • Triglycerides
      • Total cholesterol/HDL ratio
    • Liver Profile
      • Protein, Total
      • Albumin
      • Globulin
      • A/G Ratio
      • Bilirubin, Total\
      • Alkaline Phosphatase
      • Aspartate Aminotransferase (AST)
      • Alanine Aminotransferase (ALT)
      • Gamma-Glutamyltransferase (GGT)
    • Haematology Tests
      • Haemogram
        • Haemoglobin
        • Red Blood Cell Count
        • Packed Cell Volume (HCT)
        • Red Cell Indices (MCV, MCH, MCHC)
        • Red Cell Distribution Width (RDW)
        • Mean Platelet Volume (MPV)
        • Platelet Count
        • White Blood Cell Count
        • Differential Count
        • Peripheral Blood Film
    • Endocrine (Gland) Function
      • Glucose
      • Glycated Haemoglobin (HbA1c)
    • High-sensitivity C-reactive protein (hs-CRP) Test Haematology Tests
    • Urine Test
      • Urine Albumin / Creatinine Ratio
    • Bone/Joint Profile
      • Uric Acid
    • Thyroid Function Tests
      • Free Thyroxine (Free T4)
      • Thyroid Stimulating Hormone (TSH)
  • Cardiovascular risk assessment and score using risk engines
  • 2nd Consultation with heart specialist and discussion of results
  • Pre-run advice