Sudden death in young athletes: screening for the needle in a haystack.

Nontraumatic sudden death in young athletes is always disturbing, as apparently invincible athletes, become, without warning, victims of silent heart disease. Despite public perception to the contrary, sudden death in young athletes is exceedingly rare. It most commonly occurs in male athletes, who have estimated death rates nearly fivefold greater than the rates of female athletes. Congenital cardiovascular disease is the leading cause of non-traumatic sudden athletic death, with hypertrophic cardiomyopathy being the most common cause. Screening athletes for disorders capable of provoking sudden death is a challenge because of the low prevalence of disease, and the cost and limitations of available screening tests. Current recommendations for cardiovascular screening call for a careful history and physical examination performed by a knowledgeable health care provider. Specialized testing is recommended only in cases that warrant further evaluation.