Sudden death in athletes engaged in competitive sports is a highly visible, emotionally charged and important public health issue. Substantial progress has occurred in this new area of cardiovascular medicine driven by the recent focus on the most effective and appropriate strategies for screening for the detection of otherwise unsuspected cardiovascular diseases. Detailed guidelines and consensus recommendations represent the criteria with which clinical decisions regarding management and eligibility/disqualification decisions must be decided. However, applying these guidelines is fraught with difficulty.

"Comparatively little is known about the risk of sudden death associated with exercise in young competitive athletes, and whether the benefits of sports activity outweigh the hazards of exercise-related fatal events is a clinical dilemma. This is only a small part of the story, however, as there are considerable effects of exercise whether it be at a competitive level or on a 'leisure' level on patients of all ages. This in itself is of massive importance to the cardiac patient population as exercise is a key component of effective recovery and recommended as central in the prevention of much cardiac disease."

A 27-Year-Old Professional Cyclist with Palpitations on Effort.- Impaired Performance in a Master Long-Distance Runner.- A 26-Year-Old Cyclist with Syncope on Effort.- A 32-Year-Old Female Soccer Player with Unexplained Syncope.- A 23-Year-Old Top-Level Soccer Player Suffering Syncope on Effort.- A 21-Year-Old Female Beach Volleyball Player with Palpitations and Pre-syncope on Effort.- A 49-Year-Old Male Marathon Runner with Exercise Induced Prolonged Palpitations.- A Female Cyclist with Prolonged Palpitations on Effort.- The Girl with Systolic Murmur on the Left Sternal Border.- Elite Tennis Player with a Complete Atrio-Ventricular Block.- A Young Canoeist with an Abnormal Electrocardiogram.- ECG Repolarization Abnormalities in an African Descent Athlete: Pathologic or Physiologic Finding?.- A 16-Year-Old Female Runner with Prolonged QT Interval.- Athlete with Variable QTc Interval and Abnormal T Wave Pattern.- Young Triathlete with Unusual ST-Segment Elevation in Precordial Leads.- A 17-Year-Old Competitive Soccer Player with Pre-excitation Pattern on 12-Lead ECG.- A Symptomatic Judoka with Wolff-Parkinson-White Pattern.- A 35-Year-Old Competitive Cyclist with Frequent Premature Ventricular Beats.- An Athlete with Ischemic Pattern on Exercise ECG.- A 17-Year-Old National Cyclist with Exercise-Induced Ventricular Tachycardia.- A 53-Year-Old Recreational Jogger with Atrial Fibrillation.- Paroxysmal Atrial Fibrillation in a Professional Cyclist.- A Female Soccer Player with Unusual Fatigability and Ventricular Arrhythmia.- A 38-Year-Old Marathon Runner with Tricuspid Valve Regurgitation.- A Young Rower with an Unusual Left Ventricular Hypertrophy.- An Elite Athlete with Controversial Left Ventricular Hypertrophy.- A Non-compaction Cardiomyopathy or Innocent LV Trabeculation?.- A 31-Year-Old Male, Recreational Soccer Player with "Low Risk" Hypertrophic Cardiomyopathy.- Competitive Cyclist Suffering from Myocardial Infarction, Willing to Resume Competitive Sport.- A 32 Year-Old Male Soccer Player with Chest Trauma.- Asymptomatic Cyclist with Stenosis of Left Main Coronary Artery.