Intended for healthcare professionals

Clinical Review

Preparticipation screening for cardiovascular abnormalities in young competitive athletes

BMJ 2008; 337 doi: (Published 29 September 2008) Cite this as: BMJ 2008;337:a1596
  1. Michael Papadakis, cardiac research registrar12,
  2. Greg Whyte, professor of sports sciences3,
  3. Sanjay Sharma, consultant cardiologist, and director of heart muscle diseases12
  1. 1King’s College Hospital, London SE5 9RS
  2. 2University Hospital Lewisham, London
  3. 3CRY Sports Cardiology Centre, Olympic Medical Institute, Northwick Park Hospital, Middlesex
  1. Correspondence to: S Sharma ssharma21{at}
  • Accepted 1 August 2008

The cardiovascular benefits of regular physical exercise are well established.1 However, a small proportion of young (≤35 years) athletes with unsuspected heart disease are at increased risk of exercise related sudden cardiac death.2 The majority of such deaths are attributable to cardiac anomalies,2 3 4 most of which can be identified during life. A range of therapeutic strategies can be implemented to prevent fatalities, raising support for screening young athletes in medical and sporting communities.5 6 7 8 9 The efficacy, cost effectiveness, and impact of false positive tests of preparticipation screening strategies are, however, controversial. This article provides a factual overview of preparticipation screening, as more general practitioners are likely to be confronted with the questions relating to cardiovascular screening in athletes in countries where systematic screening programmes are currently not available.

Summary points

  • Regular exercise is beneficial and only a small number of athletes with silent cardiovascular disease are at increased risk of sudden cardiac death during exercise

  • Preparticipation screening using health questionnaires and physical examination only has poor sensitivity whereas elaborate screening programmes are cost prohibitive

  • Screening with 12 lead electrocardiography prevents sudden cardiac death from channelopathies and cardiomyopathies but not from coronary artery disease

  • Electrocardiography may vary depending on athletic activity, age, race, and sex, and skilled doctors are required to avoid a large number of false positive test results

  • Implementation of preparticipation screening is currently hampered by the lack of resources and infrastructure and cannot be regarded as cost effective in most countries

Sources and selection criteria

We searched PubMed and Medline from 1980 onwards using the search terms “pre-participation screening”, “sudden death”, “electrocardiogram”, “athletes”, “black athletes”, and “cost-effectiveness”. Although we scrutinised and selected the highest quality articles, comprising original papers, reviews, recommendations, and consensus reports, the studies are all population based, prospective or retrospective observational reports. …

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