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Pre-participation screening of young competitive athletes

Sudden cardiac arrest is most often the first clinical manifestation of an underlying cardiovascular disease and usually occurs in previously asymptomatic athletes. The risk–benefit ratio of physical exercise differs between young competitive athletes and middle-aged/senior individuals engaged in leisure-time sports activity. Competitive sports are associated with an increased risk of sudden cardiovascular death in susceptible adolescents and young adults with underlying cardiovascular disorders. In middle-aged/older individuals, physical activity can be regarded as a ‘two-edged sword’: vigorous exertion increases the incidence of acute coronary events in those who do not exercise regularly, whereas habitual physical activity reduces the overall risk of myocardial infarction and sudden cardiac death. Although cardiovascular pre-participation evaluation offers the potential to identify athletes with life-threatening cardiovascular abnormalities before the onset of symptoms and may reduce their risk of sudden death, there is a significant debate among cardiologists about its efficacy, the impact of false-positive results, and the cost-effectiveness of routine screening. This chapter presents an appraisal of the available data and criticisms concerning screening programmes aimed at preventing sudden death of either young competitive athletes or older individuals engaged in leisure-time sports activity.