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Controversies relating to preparticipation cardiovascular screening in young athletes: time for a realistic solution?
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  1. M Papadakis1,2,
  2. N Chandra1,2,
  3. S Sharma1,2
  1. 1King's College Hospital, London, UK
  2. 2University Hospital Lewisham, London, UK
  1. Correspondence to Professor Sanjay Sharma, King's College Hospital, Denmark Hill, London SE5 9RS, UK; ssharma21{at}hotmail.com

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The sudden death of any young individual is a tragic event that causes immeasurable damage to family lives. The sudden death of a young athlete from a cardiac disorder is particularly emotive and is often associated with considerable media coverage, drawing attention to the youth, the athletic prowess of the individual and the number of life years lost consequent to a cardiac disorder that could have been detected during life. Most exercise-related sudden cardiac deaths (SCDs) are attributed to congenital or hereditary cardiac disorders that are asymptomatic in most victims.1 2 Unsurprisingly, the death of a young athlete often galvanises urgent discussions relating to preparticipation cardiac screening involving members of the community, sports physicians and sporting governing bodies.

There is considerable resistance to implementing widespread cardiac screening of athletes. The low incidence of deaths and the low prevalence rates of all implicated disorders challenge the cost efficacy of such a programme. Furthermore, there are concerns relating to the overlap between the physiological adaptation to exercise and the cardiac disease resulting in false-positive results and unnecessary anxiety or even disqualification of an athlete from future competitive sport.3 It is also recognised that up to 11% of deaths in athletes occur at rest; therefore, cessation of sport will not necessarily prevent death in all athletes.1 Finally, there are issues relating to the lack of infrastructure and expert personnel trained in athlete's heart and the broad phenotype of the heterogeneous disorders implicated in the sudden death of an athlete. The UK and many other Western countries do not favour screening of athletes. Indeed, screening of athletes in the UK is confined to elite sporting …

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