ABSTRACT
The unexpected collapse of a young athlete during training or competition engenders a high level of anxiety among athletes as well as their coaches and parents. Despite the highly publicized events of sudden death in athletes, the chance that such collapse indicates a risk for a cardiac-related tragedy is extremely remote. In most cases, collapse of an athlete can be explained by more benign causes, such as hyperventilation, dehydration, and post-exercise pooling of blood in the lower extremities. Nonetheless, in the evaluation of an athlete who has collapsed, the paramount goal of the physician is to rule out the presence of underlying occult cardiac disease. Not uncommonly, however, no etiology—worrisome nor benign—is found for the collapse, creating a difficult decision-making dilemma regarding clearance for future participation in sports. Amidst such uncertainty, the physician must weigh the available information concerning the nature of the event, findings on medical history and physical examination, and outcomes of laboratory testing. The final adoption of a permissive or conservative approach regarding return-to-play must consider the small possibility of unrecognized risk versus the damaging effects of unnecessarily restricting a young athlete from sports play.
