General guidelines for athletes screening, clearing for and disqualification from sports with regard to sudden cardiac death risk

The following review presents cardiological recommendations for clearing for or disqualifying from participation in sports as means of preventing sudden cardiac deaths on the sports field. The discussion involves pre-participation screening. The state of screening programs implemented in Europe, USA and Poland, targeting mainly changes in cardiovascular system, is presented here too; so is physiological and pathological heart remodeling resulting from physical exercise stimulation. The limits for degree of physiological athlete's heart remodeling have been defined to distinguish it from pathological heart remodeling. Athlete disqualification criteria are based on documents originating at the 36th American Bethesda Conference and recommendations from the European Society of Cardiology. Special attention has been given to the most common pathologies, namely: hypertrophic cardiomiopathy, Marfan's syndrome, ion channelopathies and arrhythmias. Studies show that the use of screening methods by Italian doctors lowers the number of sudden cardiac deaths during sports competitions. The diagnosis of cardiovascular anomalies in competitive athletes should be very restrictive and other countries should follow the Italian procedures. There is a need to modify the recommendations in order to decrease the controversy concerning the qualification for and disqualification from participating in sports.