Sudden cardiac death in young athletes: practical challenges and diagnostic dilemmas

Sudden cardiac death (SCD) in an athlete is a rare yet highly visible tragedy that generates significant media attention and discussion among medical personnel, sports communities, and laypersons alike. The incidence of SCD is greater in athletes compared with their nonathletic counterparts due to the increased risk associated with strenuous exercise in the context of a quiescent cardiac abnormality. Numerous structural, electrical, and acquired cardiovascular abnormalities are capable of causing SCD, many of which can be identified during life and managed by lifestyle modifications, pharmacotherapy, and device therapy. Strategies for the prevention of SCD, including pre-participation cardiovascular screening, are endorsed by sports governing bodies, but mandatory pre-participation cardiovascular screening remains rare. Evaluation of athletes poses diagnostic difficulties, particularly differentiating between physiological adaptation to exercise, known as athlete's heart, and cardiomyopathic processes capable of causing SCD. This paper provides a detailed review regarding the etiology of SCD in young athletes and provides insight into the challenges and dilemmas faced when evaluating athletes for underlying pathological conditions.