Sports cardiology for the general cardiologist

Sports cardiology has emerged as a distinct subspecialty at the intersection of preventive cardiology and athlete care. While regular exercise confers substantial cardiovascular benefits, vigorous exertion can unmask latent disease and precipitate sudden cardiac death (SCD), particularly in predisposed individuals. Although uncommon, such events carry profound societal impact and underscore the importance of early detection, risk stratification and tailored management. This primer reviews the epidemiology of SCD in athletes, noting the demographic variations in risk and the spectrum of conditions implicated. The role of preparticipation cardiac screening is examined, with emphasis on the utility and limitations of the 12-lead ECG. Physiological, electrical, structural and functional adaptations of the ‘athlete’s heart’ are outlined, along with practical guidance for distinguishing these benign changes from cardiomyopathy. Secondary diagnostic strategies, including echocardiography, cardiovascular MRI, stress testing and genetic evaluation, are discussed in the context of differentiating adaptation from disease. Management principles focus on evidence-based risk stratification, safe exercise prescription and shared decision-making. Specific recommendations are provided for structural heart disease, electrical disorders, myocarditis, congenital anomalies and survivors of cardiac arrest. Emerging data on master athletes, atrial fibrillation, coronary calcification and myocardial fibrosis are highlighted.