Sudden cardiac death in athletes, while uncommon, is a terrifying thing for any parent of young athletes to ponder. Each year, about 100 to 200 pediatric sudden deaths are recorded in the United States. This means an estimated 1 to 2 children per 100,000 children die suddenly every year.

These sudden deaths are often caused by undiagnosed cardiac abnormalities. In Italy and other European countries, teen and adult athletes are screened for heart conditions before they play sports, which is an action some researchers hope will take off in the United States.

However, studies show that these screenings, like the commonly used echocardiogram (ECG), may not give researchers the answers they need. And, while ECGs are inexpensive, about $10 per test, those individuals that have abnormal findings could need more testing at $2,000 per student athlete.

Thus, ECGs are not necessarily the best first-line test to rule out a heart problem, and they may keep young children out of sports unnecessarily, due to false-positive test results. Instead, an athlete’s primary care physician should use a pre-participation symptom assessment as a more accurate way to screen prior to sports participation.

Providers should also ask about behavior and family history, with questions like:

  • Have you ever fainted during exercise?
  • Have you ever fainted after exercising?
  • Have you ever had extreme shortness of breath during exercise?
  • Are there any family members who died suddenly and unexpectedly before age 50?
  • Are there any family members who died suddenly of “heart problems” before age 50?
  • Are there any family members who have had unexplained fainting or seizures?

If a child’s history or family history shows an increased risk, then further testing would be needed.


Charles Berul Charles Berul, MD, is division chief of Cardiology and co-director of the Children's National Heart Institute and holds the Van Metre Companies Professorship in Cardiology. He was born in Washington, DC and raised in the area.

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