Your athlete passed their sports physical. What did the exam check?
Published 09/28/2026
Most sports physicals take about fifteen minutes, and the heart portion is 14 specific elements: ten questions and four things a doctor checks by hand. Knowing what's on that list, and what it depends on, tells you a lot about what a signed clearance form does and doesn't establish.
The form came back signed. Fifteen minutes, maybe twenty. Height, weight, blood pressure. A stethoscope on the chest and the back. Knees and shoulders checked. Cleared to play. What does the heart portion actually cover?
The cardiac screen is 14 elements
The American Heart Association and the American College of Cardiology recommend a 14-element cardiovascular screen inside the preparticipation physical. Ten of them are questions. Four are things a clinician checks in the room.
The personal history questions ask about chest pain or pressure during exertion, unexplained fainting or near-fainting, unusual shortness of breath or fatigue with exercise, a heart murmur someone has noted before, high blood pressure, any previous restriction from sports, and any heart testing your athlete has already had.
The family history questions ask about a close relative who died suddenly or unexpectedly at a young age, disability from heart disease in a relative under 50, and known inherited conditions (i.e., hypertrophic or dilated cardiomyopathy, long QT syndrome and other ion channel disorders, Marfan syndrome, or serious arrhythmias).
The physical exam listens for a heart murmur, checks femoral pulses for narrowing of the aorta, looks for the physical signs of Marfan syndrome, and measures blood pressure in the arm. That is the cardiac screen. If nothing on the list turns up, the form gets signed and your athlete is cleared to play.
Those questions depend on symptoms that are often absent
Here's the part worth understanding. A history questionnaire can only surface what someone has already noticed.
Sudden cardiac arrest is the leading cause of death on school campuses and the number one killer of student athletes. About 70% of athletes who died of sudden cardiac death had reported no symptoms beforehand. Around one in 300 young people has an undetected heart condition that puts them at risk.
Those numbers aren't here to alarm you. They describe a mechanism. If your athlete has never fainted, never had chest pain with exercise, and has no family history anyone knows about, all ten history questions get an honest clean answer. A condition, if there is one, simply isn't in the range of what those questions can see.
Keep the scale in view too. Estimates of sudden cardiac death in athletes run somewhere between about 1 in 40,000 and 1 in 80,000 athletes per year. No national registry exists, so any tighter figure is guesswork. It is rare but it is also the leading cause of death among student athletes.
Detection is one layer. Response is the other.
No screen catches everything, which is why the first few minutes of an emergency matter as much as anything on a clearance form. For every minute without defibrillation, the chance of survival drops about 10%. CPR, especially when it starts immediately, can double or triple a person's chance of survival. Some critical items include, an automated external defibrillator (AED) within reach of the field, coaches who are trained and current, and a written plan naming who calls 911 and who runs for the AED.
What to do before the next physical
Spend ten minutes on the family history half before you go. Call the aunt who would know. Ask what your grandfather actually died of, and at what age. Bring what you find to the appointment and say it out loud, because that half of the screen is only as good as what you can tell the doctor. If anything on the list gives you pause, ask your doctor directly what it means for your athlete.
If you run a league, school, or club and want to learn about our AED donation program, email amy@iplaywithheart.org.