Sports Medicine

, Volume 24, Issue 2, pp 97–119 | Cite as

Cardiovascular Evaluation of the Athlete

Issues Regarding Performance, Screening and Sudden Cardiac Death
  • Barry A. Franklin
  • Gerald F. Fletcher
  • Neil F. Gordon
  • Timothy D. Noakes
  • Philip A. Ades
  • Gary J. Balady
Review Article


Recent studies have reported ECG anomalies and a high prevalence of exercise-related arrhythmias among well trained, apparently healthy endurance athletes with superior levels of cardiorespiratory fitness. The occurrence of sudden and premature cardiac deaths in amateur and professional athletes, who appear to embody all of the virtues of health and fitness, has raised our consciousness regarding the underlying atherosclerotic or nonatherosclerotic causes, and the need for, and extent of, preparticipation screening in competitive athletes. It appears that strenuous physical activity may trigger acute cardiovascular events in some athletes. Coronary artery disease is the most frequent autopsy finding in those over the age of 35 years who die suddenly. In contrast, structural cardiovascular abnormalities, including hypertrophic cardiomyopathy and malformations of the coronary arteries, are the major cause of sudden death in younger athletes. This article reviews these issues, with specific reference to the assessment of cardiorespiratory fitness, legal and prohibited performance-altering medications, the pathophysiological basis of exertion-related untoward events, the athlete at risk, limitations of conventional screening programmes and contemporary recommendations to identify latent cardiovascular disease in athletic populations.


Adis International Limited Sudden Cardiac Death Hypertrophic Cardiomyopathy Cardiorespiratory Fitness Anaerobic Threshold 
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Copyright information

© Adis International Limited 1997

Authors and Affiliations

  • Barry A. Franklin
    • 1
    • 7
  • Gerald F. Fletcher
    • 2
  • Neil F. Gordon
    • 3
  • Timothy D. Noakes
    • 4
  • Philip A. Ades
    • 5
  • Gary J. Balady
    • 6
  1. 1.Cardiac Rehabilitation and Exercise LaboratoriesWilliam Beaumont HospitalDetroitUSA
  2. 2.Mayo Clinic and Mayo Medical SchoolJacksonvilleUSA
  3. 3.The Heart and Lung Group of Savannah and Center for Heart Disease PreventionChandler HospitalSavannahUSA
  4. 4.Department of PhysiologyUniversity of Cape Town Medical School and Sports Science Institute of South AfricaNewlandsSouth Africa
  5. 5.Cardiac Rehabilitation ProgramUniversity of Vermont College of MedicineBurlingtonUSA
  6. 6.Boston University School of MedicineBostonUSA
  7. 7.Department of PhysiologyWayne State University, School of MedicineDetroitUSA

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