No further testing is required in this patient. For persons undergoing a preparticipation sports evaluation, current American Heart Association guidelines consist of a 12-step clinical history and physical examination focused on cardiovascular screening. The elements of this examination include obtaining a family history for evidence of heart disease or premature death, evaluating the patient for cardiac-related symptoms (such as unexplained near-syncope/syncope or exertional dyspnea or fatigue), and performing a physical examination. Physical examination findings in patients with hypertrophic cardiomyopathy (HCM) usually include a systolic crescendo-decrescendo murmur frequently heard best at the left lower sternal border, which is due to left ventricular outflow tract obstruction. The murmur of HCM is augmented by maneuvers that decrease venous return (Valsalva) and is diminished by those that increase preload (leg elevation) or increase afterload (handgrip). Additional testing, with either cardiovascular imaging or electrocardiography, is not indicated in the absence of suspicious symptoms, physical findings, or family history. Therefore, no further testing is indicated in this patient with normal findings on physical examination and no suspicious symptoms or historical findings.

Because HCM is the most common cause of sudden cardiac death in persons younger than age 35 years, especially during athletic training and competition, evaluating for this diagnosis is often the focus of a preparticipation sports evaluation. However, the routine use of electrocardiography, echocardiography, or electrocardiographic stress testing to exclude HCM in the United States is probably impractical, lacks proven cost-effectiveness, and would require considerable infrastructure that currently does not exist. Additionally, such screening also could potentially cause harm to many young athletes because of false-positive results that would lead to unnecessary further evaluation, anxiety, and possibly unwarranted disqualification from sports. These guidelines differ from recommendations in Europe, where a 12-lead electrocardiogram is often incorporated into preparticipation sports evaluations. Focused screening is indicated only for first-degree relatives of patients with HCM, with the timing of screening intervals based on age, aerobic activity, family history, and clinical suspicion. Screening in these individuals includes electrocardiography and an imaging study in addition to a comprehensive history and physical examination.