HeartYoung

of theValley
Athlete
Heart of theValley
Cardiopulmonary Assessment
Young Athlete
Cardiopulmonary Assessment
Young Athlete Assessment Information for
Athlete, Family and Provider
Main Clinic: Pleasanton Clinic
5933 Coronado Lane, Suite 1 F Don’t let unidentified asthma
Pleasanton, CA 94588
slow your athlete down!
Our Cardiopulmonary Assessment Services: Satellite Clinics:
Fremont, Tracy, Brentwood, San Mateo
* Assessment of pulmonary function.
* Assessment of exercise capacity (physical fitness)
as measured by maximal oxygen consumption
(VO2max) and other metabolic parameters.
* Detection of exercise-induced asthma and
assessment of response to medications
* Detection of vocal cord dysfunction syndrome
* Education and counseling for families Please visit our website for locations of satellite clinics
at www.heartofthevalley.us

Metabolic Testing during bicycle ergometry. Parameters tested include Maxi- Cardiopulmonary Assessments are performed
mal Oxygen Consumption, Work, Anaerobic Threshold, Heart Rate Rise only in our Pleasanton Clinic.
Andrew J. Maxwell, MD, FACC
Dr. Maxwell is a Board Certified Pediatric Heart of the Valley Pediatric Cardiology
Cardiologist and Pediatrician. He received his APPTS. AND REFERRALS: is a full-service pediatric cardiology clinic
medical degree from Johns Hopkins Medical
School, completed a Residency in Pediatrics Contact us at 925-416-0100 serving expecting parents, infants, children and
at UCSF and Fellowships in Pediatric Cardiol- young adults.
ogy at Packard Children’s Hospital at Stanford MORE INFORMATION:
and Children’s Hospital of Philadelphia. He has
been in private practice since 2002. visit www.heartofthevalley.us
 HEART OF THE VALLEY - Young Athlete Assessment
Why assess cardiac and pulmonary fitness in young
athletes?
Top athletic performance requires perfect cardiac and
pulmonary function. Two of the most common limitations
to athletic performance is under-conditioning (inadequate
training) and unrecognized, untreated asthma. There are
other cardiac and pulmonary problems that are less
common that go unrecognized as well. All of these issues
can be detected by cardiopulmonary athletic assessment.
Asthma
About 1 in 5 young athletes have some form and degree of
asthma and most of these athletes manifest worse asthma
during exercise. Unrecognized asthma is the single most
common cause of exertional chest pain, shortness of breath
and dizziness in young people. Alternatively, these
symptoms can also be caused by serious cardiac problems.
Inadequate Training
Under-conditioning can also explain athletic under-
performance. For athletes who have demonstrated no other
underlying cause, parameters of physical fitness may point
to a lack of sufficient training.
Other Causes of Limitations
Another limitation to performance that is less common is
dysfunction of the vocal cords leading to sudden breathing
difficulty at peak-intensity performance. Unrecognized car-
diac defects also occasionally interfere with performance.
What tests are used to assess cardiopulmonary fitness?
Physical fitness and conditioning is best measured using
bicycle or treadmill testing with metabolic analysis. These
methods measure different parameters of physical fitness
such as maximal oxygen consumption, maximal work
performed, anaerobic threshold, and heart rate rise.
Unrecognized asthma and vocal cord dysfunction may be
detected from a combination of pulmonary function testing
and exercise stress testing with treadmill or bicycle.
Abnormalities found by these assessments may be followed
by additional studies such as an ultrasound or an ECG.
Are there limitations of this assessment?
Not all asthma is reproducible in the clinic setting and so may
not be detected even though it exists. Not all cardiac and pulmo-
nary problems can be detected by these non-invasive tests.
Assessing pulmonary function: an athlete breaths through the apparatus
first slowly and then with as much force as possible. This is done before
exercise to obtain a baseline assessment. It is repeated after exercise
to determine the presence of exercise-induced asthma. It may then be
repeated a third time, after a pulmonary bronchodilator is inhaled, to
determine if lung function can be corrected to normal.
Assessing Exercise Functional Capacity: This can be done with either
Treadmill Testing or Bicycle Ergometry. In either case, an athlete is asked
to perform to exhaustion while being monitored with ECG.
Pulmonary Function Testing: Produces Flow-Volume Loops. Normal
healthy lungs produce loops that touch the black dots. This athlete dem-
onstrated very mild asthma at baseline (red line in left panel), Following
treadmill running to exhaustion the athlete demonatrated a marked reduction
in lung function or exercise-induced asthma (blue line in left panel). Twenty
minutes after inhaling albuterol, the athlete demonstrated supra-normal lung
function (right). Other medications may improve lung function further.
Who might benefit from a cardiopulmonary assessment?
All participants in competitive sports should consider this
assessment and particularly those who feel their athletic
performance is hampered and certainly anyone who has the
following symptoms in the table below:
Athlete History Questions: Has your athlete ever...
..had extreme fatigue associated with exercise (different
from peers)?
..had unusual or extreme shortness of breath during
exercise?
..had discomfort, pain, or pressure in his/her chest during
exercise?
..complained of his/her heart “racing or skipping beats?
..passed out during or after exercise?
How is an assessment paid for?
If an athlete has none of the symptoms above then the ex-
pense is usually paid out-of-pocket. If symptoms are present
or a medical abnormality is detected, insurance usually cov-
ers the evaluation.