Sports cardiology: heart checks for athletes, inherited conditions and safe exercise

Sports cardiology sits between cardiology and sport and exercise medicine. It has two main aims: to detect or exclude heart disease in people who exercise intensively, particularly conditions that carry a risk of sudden cardiac arrest, and to advise people with known heart conditions on how much and what type of exercise is safe. It also helps interpret the normal changes that occur in a trained heart, which can resemble disease on tests and cause confusion.

The specialist is usually a consultant cardiologist with additional interest and experience in athlete heart disease, imaging and inherited cardiac conditions, working with sport and exercise medicine physicians, specialist nurses and cardiac physiologists. The Faculty of Sport and Exercise Medicine UK describes itself as promoting excellence in musculoskeletal medicine, exercise medicine and team care. There is no single national sports cardiology service, and sports clubs and national governing bodies set their own screening protocols, so provision is patchy.

Most people who exercise regularly have no heart problem. Exercise reduces cardiovascular risk overall, and the aim of sports cardiology is to make exercise safer for the small number with underlying conditions.

• Cardiomyopathies, diseases of the heart muscle. The NHS describes hypertrophic cardiomyopathy, where the heart muscle thickens, and arrhythmogenic cardiomyopathy, which can affect teenagers and young adults and has caused some sudden unexplained deaths in young athletes.

• Inherited arrhythmia syndromes, such as long QT syndrome and Brugada syndrome, which affect the heart's electrical system.

• Coronary artery disease in older athletes, and congenital coronary artery anomalies in younger ones.

• Aortic disease such as that associated with Marfan syndrome, and valve disease.

• Myocarditis, inflammation of the heart muscle after an infection, which usually requires a period without intense exercise.

• Atrial fibrillation and other rhythm problems, which can be more common in long-term endurance athletes.

• Palpitations, fainting, chest pain or unusual breathlessness during exercise that need explaining.

The core assessment combines symptoms, personal and family history and examination with a resting electrocardiogram and, commonly, an echocardiogram. Questions focus on fainting during exercise, unexplained chest pain, a family history of sudden death under 50, cardiomyopathy or arrhythmia syndromes, and use of stimulants or supplements.

Whether to screen healthy young people is debated. Charities such as Cardiac Risk in the Young advocate heart screening for young people and say that among those they test, around 1 in 300 will have a potentially life-threatening condition that could benefit from advice, treatment or sometimes corrective surgery. Critics point out that an ECG can give false alarms in trained hearts and false reassurance, and that these tests are not part of a national NHS screening programme. Any screening should follow an agreed protocol and have access to expert follow-up if something is found.

Decisions about continuing sport are shared. For many conditions, modern practice favours individualised advice rather than blanket restriction, taking into account the diagnosis, risk markers, the type of sport and the athlete's wishes. Some people need to avoid competitive high-intensity sport, while others can continue with treatment, a defibrillator or lifestyle changes. For inherited conditions, the NHS says relatives may be offered genetic testing and monitoring, and early diagnosis is very important.

On the NHS, people with exercise-related symptoms are assessed by a GP and referred to cardiology, while relatives of someone who died suddenly or who has an inherited condition are seen in inherited cardiac conditions services, which generally offer clinical evaluation and genetic counselling. Routine NHS screening of asymptomatic athletes is not generally offered, though sports bodies and some professional clubs have their own arrangements.

Privately, athlete screening packages and consultations with sports cardiologists are available. Ask what tests are included, whether the ECG is interpreted using athlete-specific criteria, whether the doctor has experience with athlete hearts, what happens if an abnormality is found and whether results will be shared with your GP. Be cautious of packages that bundle large numbers of tests without clear indication.

• Is this finding a normal adaptation to training or a sign of disease, and how sure are you?

• Do I need further tests, such as MRI or a monitor, and what would change as a result?

• Is it safe for me to continue training and competing, and are there limits on intensity, type or conditions?

• Do any of my relatives need checking?

• What symptoms should make me stop exercising and seek help?

• Stop exercising and call 999 or go to A&E for chest pain, severe breathlessness, fainting or near-fainting, or palpitations with dizziness, as the NHS advises for palpitations with these symptoms.