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While sports participation, including football, is a safe and enjoyable activity for the vast majority of individuals it can be potentially harmful for some people. There are a number of cardiac conditions that can predispose people to sudden cardiac arrest (SCA) and sudden cardiac death (SCD). These are frequently asymptomatic and as a result not identified in the athlete. In addition, secondary factors associated with sports activity such as electrolyte disturbances (particularly hypokalaemia and hypomagnesaemia), drug abuse, (over) activity of the autonomic nervous system and psychosocial factors which may trigger sudden cardiac arrest (SCA) or even sudden cardiac death (SCD) need to be considered.

The primary causes of SCA and SCD are lethal arrhythmias such as ventricular tachyarrhythmias, in particular ventricular fibrillation, while bradyarrhythmias or asystole are far less common. The latter are often due to the extension of a pathological process into the conduction system, causing complete heart block without a reliable escape focus. In addition, syncope may occur during exercise in certain congenital lesions with right-to-left shunts and cyanosis. This can also occur due to dissections of the great vessels, particularly in patients with Marfan syndrome, leading to pericardial tamponade or deleterious major internal bleeding.

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Learning outcomes

By the end of this topic you should:

  • know the causes of SCA/SCD in athletes depending on the sub-group of athletes;
  • know the most important epidemiologic data on these diseases;
  • understand the different investigation options available for diagnosing cardiovascular disease;
  • be able to identify the major cardiovascular diseases seen in athletes based on their history, examination and investigation findings;
  • have an awareness of the implications of each of these conditions and an athlete’s sporting participation.


  • Read the relevant section in the FIFA Medical Manual and other required reading.
  • Review the suggested reading.
  • Complete the course quiz.

Suggested reading

Brukner and Khan’s

Clinical Sports Medicine – 4th Edition

Chapter 48 (pages 996-1023) and Chapter 49 (pages 1024-1037)


  1. Maron BJ. Sudden death in young athletes. N Engl J Med. 2003;349(11):1064-1075.
  2. Corrado D, Basso C, Schiavon M, Thiene G. Screening for hypertrophic cardiomyopathy in young athletes. N Engl J Med. 1998;339(6):364-369.
  3. Maron BJ, Thompson PD, Puffer JC, et al. Cardiovascular preparticipation screening of competitive athletes. A statement for health professionals from the sudden death committee (clinical cardiology) and congenital cardiac defects committee (cardiovascular disease in the young), American Heart Association. Circulation. 1996;94(4):850-856.
  4. Drezner JA, Ackerman MJ, Anderson J, et al. Electrocardiographic interpretation in athletes: The ‘seattle criteria’. Br J Sports Med. 2013;47(3):122-124.
  5. Maron BJ, Zipes DP, Kovacs RJ, American Heart Association Electrocardiography and Arrhythmias Committee of Council on Clinical Cardiology, Council on Cardiovascular Disease in Young, Council on Cardiovascular and Stroke Nursing, Council on Functional Genomics and Translational Biology, and American College of Cardiology. Eligibility and disqualification recommendations for competitive athletes with cardiovascular abnormalities: Preamble, principles, and general considerations: A scientific statement from the American Heart Association and American College of Cardiology. Circulation. 2015;132(22):e256-61.
  6. Pelliccia A, Fagard R, Bjornstad HH, et al. Recommendations for competitive sports participation in athletes with cardiovascular disease: A consensus document from the study group of sports cardiology of the working group of cardiac rehabilitation and exercise physiology and the working group of myocardial and pericardial diseases of the European Society of Cardiology. Eur Heart J. 2005;26(14):1422-1445.
  7. Lampert R, Olshansky B, Heidbuchel H, et al. Safety of sports for athletes with implantable cardioverter-defibrillators: Results of a prospective, multinational registry. Circulation. 2013;127(20):2021-2030.
  8. O’Mahony C, Jichi F, Pavlou M, et al. A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM risk-SCD). Eur Heart J. 2014;35(30):2010-2020.
  9. American College of Cardiology Foundation/American Heart Association Task Force on Practice, American Association for Thoracic Surgery, American Society of Echocardiography, et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: A report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Thorac Cardiovasc Surg. 2011;142(6):e153-203.
  10. Marcus FI, McKenna WJ, Sherrill D, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: Proposed modification of the task force criteria. Eur Heart J. 2010;31(7):806-814.
  11. Rossi PA. Arrhythmogenic right ventricular dysplasia–clinical features. Eur Heart J. 1989;10 Suppl D:7-9.
  12. Brothers JA, Paridon SM. The new AHA/ACC guidelines for competitive sports participation in young athletes with anomalous coronary arteries: The evolution of change. World J Pediatr Congenit Heart Surg. 2016;7(2):241-244.
  13. Pelliccia A, Zipes DP, Maron BJ. Bethesda conference #36 and the European Society of Cardiology consensus recommendations revisited a comparison of U.S. and European criteria for eligibility and disqualification of competitive athletes with cardiovascular abnormalities. J Am Coll Cardiol. 2008;52(24):1990-1996.
  14. Webster G, Berul CI. An update on channelopathies: From mechanisms to management. Circulation. 2013;127(1):126-140.
  15. Johnson JN, Ackerman MJ. QTc: How long is too long? Br J Sports Med. 2009;43(9):657-662.
  16. Zipes DP, Ackerman MJ, Estes NA,3rd, Grant AO, Myerburg RJ, Van Hare G. Task force 7: Arrhythmias. J Am Coll Cardiol. 2005;45(8):1354-1363.
  17. Loeys BL, Dietz HC, Braverman AC, et al. The revised ghent nosology for the marfan syndrome. J Med Genet. 2010;47(7):476-485.
  18. Scharhag J, Meyer T. Return to play after acute infectious disease in football players. J Sports Sci. 2014;32(13):1237-1242.
  19. Maron BJ, Estes NA,3rd. Commotio cordis. N Engl J Med. 2010;362(10):917-927.
  20. Dvorak J, Kramer EB, Schmied CM, et al. The FIFA medical emergency bag and FIFA 11 steps to prevent sudden cardiac death: Setting a global standard and promoting consistent football field emergency care. Br J Sports Med. 2013;47(18):1199-1202.
  21. Drezner JA. Preparing for sudden cardiac arrest – the essential role of automated external defibrillators in athletic medicine: A critical review. Br J Sports Med. 2009;43(9):702-707.