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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.

Sports cardiology and pre-participation assessment

Cardiology · UK scope · Sources checked 27 Aug 2026 · Clinical 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.
  • Training can cause sinus bradycardia, increased voltages and early repolarisation; physiological patterns must be separated from pathological T-wave inversion, pre-excitation, long QT or Brugada patterns.
  • Exercise testing should reproduce the sport's workload; stopping at 85% of age-predicted maximum may miss exercise-induced arrhythmia.
  • Eligibility is disease-, phenotype-, sport- and intensity-specific and should use shared decision-making rather than blanket exclusion.
  • Every sports setting should have a rehearsed emergency action plan with an immediately accessible AED.

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.

  1. Define the sport, intensity, training volume, performance-enhancing substances and personal goals.
  2. Take symptom and three-generation family history; examine BP, pulses, heart and syndromic features.
  3. Obtain a resting ECG for competitive/professional assessment and interpret with athlete-specific criteria.
  4. Clear low-risk findings or route any red flag to targeted testing before high-intensity participation.
Open full textbook →Answer 2 questionsCardiology check
Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

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.

  • ESC 2020 sports cardiology guidelineAssessment and disease-specific participation.
  • ESC sports cardiology pocket guidelinePractical condition framework.
  • Resuscitation Council UK field-of-play guidelineRecognition, CPR, AED and transfer.
  • Resuscitation Council UK adult BLS 2025National CPR and AED sequence.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom