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On 26 June 2003, Marc-Vivien Foé from Cameroon collapsed on the pitch during the 72nd minute of the FIFA Confederations Cup semi-final against Colombia. A national hero and international soccer star, his sudden death from hypertrophic cardiomyopathy came as a shock to the worldwide sporting community. His stunning death, an example of the tragic loss of any young athlete, reminds us all of the fragility of life.

Adapted from report in Br J Sports Med



The sudden death of a young sportsperson on the playing field is a most devastating event. Sudden cardiac death (SCD) is the leading cause of mortality in young athletes during exercise and typically is the result of undiagnosed structural or electrical cardiovascular disease.15 SCD is always tragic, and it profoundly impacts the community, school, and team where it occurs.


Athletes are viewed as the healthiest segment of our society, and exercise and sport are widely encouraged to prevent illness and promote health. However, intense exercise and physical conditioning also may trigger an acute cardiovascular event or sudden cardiac arrest (SCA) in young individuals harboring silent hereditary or congenital heart disease. This “exercise paradox” is highlighted by the sudden death of a young athlete during training or competition.


Because of the importance of this topic, and the large number of advances in recent years, SCD has a dedicated chapter. The clinical approach to other cardiac symptoms (such as chest pain, syncope, dyspnea) is addressed in Chapter 49. The main goals in this chapter are to:


  • review the incidence of SCD in young athletes—this is not a “rare” occurrence

  • clarify the etiology of SCD—sports physicians should have a detailed understanding of the various pathologies that underpin SCD, and all clinicians should be interested in the various ways the heart can fail:

  • outline how to evaluate an athlete for conditions that may cause SCD

  • address three common diagnostic conundrums that need practical solutions

  • briefly review the purpose of pre-participation cardiovascular screening

  • discuss the contemporary approach to primary and secondary prevention of SCD in sport.


Incidence of sudden cardiac death


The true incidence of SCD in sportspeople is widely debated. Accurate calculation of the incidence of SCD in athletes requires a precise numerator (number of deaths per year), and an exact denominator (number of athlete participants per year) in the population studied. The reported incidence of SCD in young athletes varies widely, and it is challenging to compare studies which have vastly different methodology and originate from different geographic regions (Table 48.1).

Table Graphic Jump Location
Table 48.1

Incidence of sudden cardiac death in children and young sportspeople

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