Cardiovascular screening of children and adolescent athletes (<14 years)

Sport is not in itself the cause of enhanced mortality. During physical activity physiological changes, such as increased catecholamine levels, acidosis, and dehydration, can trigger cardiac arrest in those young athletes who are affected by underlying cardiovascular disorders. Because sports can prompt adverse events from underlying cardiac disease, pre-participation screening has been advised as strategy in the prevention of sudden cardiac death (SCD) in competitive athletes. SCD is rare in young healthy athletes, but remains a tragic and counter-intuitive event, subject to persistently high public visibility, triggering of emotion, and media attention, with potential legal liability considerations. Pre-participation screening in children and adolescent athletes can be done by an experienced specialist (paediatrician, family doctor, cardiologist, or sports medicine specialist); it includes family and personal history, physical examination (including blood pressure), and resting 12-lead ECG. All these issues are discussed in this chapter.