The goals of evaluating individuals for exercise and sports participation are shown in table 1. The most important reason to screen for heart disease is to prevent sudden, unexpected death. Heart disease may also lead to sudden incapacity which may result in injuries, and pre-existing heart disease may be exacerbated by exercise. Also, almost all states in the USA require some type of pre-participation screening of participants in organised sports. Since there are more athletes at educational institutions than in amateur organisations and professional organisations, most physicians encounter this issue in association with high school and university sports. It has been estimated that there are 5 million active athletes at the high school, university, professional and master’s levels in the United States.¹ The sudden death rate among high school athletes is 1:100–200 000; among marathon runners 1:50 000; and among recreational joggers 1:15 000.² Thus, athletic sudden cardiac death is a rare event.

One could argue that, given this low frequency of sudden athletic death, no screening programme could possibly be cost effective. The idea of preventing such a low frequency event is challenging and the efficacy of any screening programme would be difficult to prove. Despite these clear realities, public interest in this problem is high. The reason for this was succinctly summarised by Maron and Zipes in the 36th Bethesda Conference Report: “Sudden cardiac deaths in competitive athletes continue to be highly visible, compelling emotional events with significant liability concerns. These catastrophes are frequently subjected to intense public scrutiny largely because of their occurrence in young otherwise healthy-appearing individuals, including elite participants in collegiate and professional sports”.³ Consequently, the purpose of this article is to acquaint the physician with the issue of screening athletes for heart disease and the …