Educational draft · awaiting clinical reviewThe full textbook explains uncertainty but does not replace live national or local guidance, specialist advice, or current prescribing information.
Identify cardiovascular red flags before sport, distinguish physiological adaptation from disease and create safe, individualised participation plans.
Exercise benefits cardiovascular health, but intense activity can trigger events in susceptible disease. Screening aims to find the small high-risk group without medicalising normal adaptation or offering false reassurance.
Assessment considers dynamic versus static load, competitive level, environment, medication/device issues and the athlete's values. Return to play after myocarditis, ACS, ablation or surgery needs condition-specific reassessment.
Syncope during exercise is more concerning than a typical post-exertional vasovagal episode and warrants urgent cardiac evaluation.
Exercise-related pressure, unusual breathlessness or reduced performance may represent coronary disease or anomalous coronary anatomy.
Sudden rapid palpitations, presyncope or seizure-like collapse, especially during exertion or emotion.
Sudden unexplained death before 50, inherited cardiomyopathy/channelopathy, unexplained drowning or multiple premature cardiac events.
Pathological murmur, unequal pulses/BP, Marfan features, hypertension or signs of cardiomyopathy/heart failure.
Syncope during exertion is a cardiac red flag; abrupt standing still after exertion more often causes reflex hypotension, but history must be rigorous.
Voltage criteria alone commonly reflect training, whereas lateral T-wave inversion or pathological Q waves require evaluation.
A submaximal treadmill may not reproduce an arrhythmia that appears only at the athlete's training intensity.
Document residual uncertainty, warning symptoms and emergency planning when participation continues with disease.
A device locked remotely from the field undermines the emergency plan; immediate access and rehearsal matter.
Reassuring exertional syncope as a simple faint without cardiac investigation.
Calling normal athletic voltage hypertrophy cardiomyopathy without considering athlete criteria.
Ending exercise testing at 85% predicted heart rate when symptoms occur only at higher workload.
Using one universal restriction for all genotypes, phenotypes and sports.
Keeping the AED locked or too distant to permit rapid defibrillation.
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A footballer collapses, is unresponsive and has occasional gasps. What is the immediate priority?
National guidance is shown before implementation-dependent detail. Apply principles in context and verify current guidance when a decision affects care. Source check completed 27 Aug 2026; clinical approval remains outstanding.
Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes