Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Rapidathletepre-participationexercise ECGsudden cardiac arrestreturn to play
Sports cardiology and pre-participation assessment
Essential points for quick revision.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Escalate
An athlete who collapses and is unresponsive with abnormal breathing is in presumed cardiac arrest: call 999, start high-quality CPR and attach an AED immediately. Do not delay defibrillation to move the athlete from the field of play.
Synopsis
Identify cardiovascular red flags before sport, distinguish physiological adaptation from disease and create safe, individualised participation plans.
Pre-participation assessment starts with personal symptoms, family history, examination and—especially for competitive/professional athletes—a resting 12-lead ECG interpreted using athlete-specific criteria.
Exertional syncope, chest pain, disproportionate dyspnoea or abrupt palpitations is a stop-and-investigate signal.
Ask about sudden unexplained death, cardiomyopathy, channelopathy and premature coronary disease in relatives.
Key red flags
Exertional syncope
Syncope during exercise is more concerning than a typical post-exertional vasovagal episode and warrants urgent cardiac evaluation.
Investigation priorities
01
Resting 12-lead ECGFirst step
Screen electrical disease and cardiomyopathy clues in competitive/professional assessment.
Management branches
FirstPre-participation evaluation
Competitive/professional sport or a participant with symptoms, disease or family risk.
Define the sport, intensity, training volume, performance-enhancing substances and personal goals.
Take symptom and three-generation family history; examine BP, pulses, heart and syndromic features.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.