Dr. Alessandro Giardini
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Regular exercise is one of the most important things a child can do for their physical and mental health. The vast majority of children and teenagers who participate in sport have completely healthy hearts and can exercise without any restriction. In a small number, however, an undetected heart condition may pose a risk during intense physical activity. The purpose of sport cardiology is to identify these children, provide clear guidance, and ensure that every young person can be as active as safely possible.
Dr Giardini is a Consultant Paediatric Cardiologist at Great Ormond Street Hospital and the Portland Hospital with extensive training and published research in exercise physiology and paediatric cardiology. He provides expert cardiac assessment, screening and individualised exercise guidance to children and teenagers who participate in sport at any level, from recreational activity through to elite and professional competition. His approach is always to enable physical activity rather than restrict it, ensuring that decisions are based on a thorough understanding of each child's heart.
There are three main reasons why families seek a sport cardiology assessment.
The first is pre-participation cardiac screening. Parents of children entering competitive sport, joining a football academy, training at club level, or beginning any intensive athletic programme often want to know that their child's heart is healthy before they push it hard. Screening provides that certainty. Although sudden cardiac death in young athletes is rare (estimated at approximately 1 in 50,000 to 1 in 80,000 per year), many of the conditions responsible are identifiable through screening and are treatable when found. Knowing your child's heart is normal before they compete is not just peace of mind. In some cases, it can be lifesaving.
The second is exercise-related symptoms. Any child who experiences chest pain, palpitations, unusual breathlessness, dizziness or fainting during or after exercise should be assessed by a cardiologist before continuing sport. These symptoms are often benign, but they can occasionally be the first sign of a condition that needs to be identified and managed. Dr Giardini regularly sees children referred with exercise symptoms and can determine quickly whether the cause is cardiac or non-cardiac.
The third is exercise guidance for children with known heart conditions. Children with congenital heart defects, cardiomyopathy, arrhythmias, or other cardiac diagnoses benefit enormously from regular physical activity, but some may need a personalised exercise prescription that matches their specific cardiac function. Too often, children with heart conditions are told simply to "take it easy" without any precise guidance. Dr Giardini's expertise in exercise physiology means he can provide specific, evidence-based recommendations about which sports are safe, what intensity is appropriate, and what restrictions, if any, are genuinely necessary. The aim is always to maximise the amount of physical activity a child can safely enjoy.
Cardiac screening is particularly relevant for children and teenagers entering competitive sport at club level or above, whether in football, athletics, swimming, rugby, cycling, rowing or any other discipline. It is also recommended for children with symptoms during exercise (chest pain, palpitations, breathlessness disproportionate to effort, dizziness or fainting), children with a family history of inherited cardiac conditions such as hypertrophic cardiomyopathy, Long QT syndrome, Brugada syndrome or arrhythmogenic right ventricular cardiomyopathy, families where there has been an unexplained sudden death or cardiac arrest in a relative under the age of 50, children with a known heart condition who wish to participate in competitive sport and need formal clearance, and children being considered for elite or professional sporting pathways where a cardiac assessment is required by the sporting body or academy.
Screening is most commonly requested from around the age of 12 to 14, when children begin competing more seriously, but it is appropriate at any age if symptoms, family history or clinical findings raise concern.
Dr Giardini provides a comprehensive cardiac assessment in a single appointment, with all tests performed and interpreted on the same day. There is no waiting for separate scan bookings or delayed results. Families leave the consultation with a clear, definitive answer.
The assessment begins with a detailed medical and family history. This is one of the most informative parts of the screening, covering personal symptoms, past medical history, exercise tolerance, and any family history of heart conditions, sudden deaths or unexplained fainting in young relatives.
A full cardiovascular examination follows, including listening to the heart for murmurs, checking blood pressure, and looking for physical features that may suggest an underlying condition, such as the tall stature and joint laxity associated with Marfan syndrome.
A 12-lead electrocardiogram (ECG) is performed to record the electrical activity of the heart. The ECG is quick, painless and can detect a wide range of conditions that are not apparent on examination alone, including hypertrophic cardiomyopathy, Long QT syndrome, Wolff-Parkinson-White syndrome, Brugada syndrome, arrhythmogenic right ventricular cardiomyopathy and other electrical abnormalities. European Society of Cardiology guidelines recommend ECG as part of pre-participation screening in competitive athletes.
An echocardiogram is performed during the same appointment. This painless ultrasound scan provides detailed, real-time images of the heart's structure and function and is the key test for identifying structural conditions such as hypertrophic cardiomyopathy, valve abnormalities, aortic dilatation and anomalous coronary arteries. Dr Giardini performs and interprets every echocardiogram personally, so findings can be explained to you immediately.
If the history, examination, ECG and echocardiogram are all normal, most families can be reassured that their child's heart is healthy and they can participate in sport without restriction. If any finding requires further investigation, Dr Giardini can arrange additional tests such as an exercise stress test (to assess the heart's response to physical exertion and unmask symptoms or rhythm disturbances that occur only during activity), 24-hour Holter monitoring (to capture intermittent rhythm problems), cardiac MRI (for more detailed structural assessment), or genetic testing where an inherited condition is suspected.
Pre-sport cardiac screening is designed to identify conditions that increase the risk of sudden cardiac events during intense physical activity. The most important of these include hypertrophic cardiomyopathy (HCM), the most common cause of sudden cardiac death in young athletes, in which the heart muscle is abnormally thickened and can obstruct blood flow or trigger dangerous heart rhythms during exertion. Long QT syndrome is an inherited electrical condition that can cause a dangerous arrhythmia called torsades de pointes, often triggered by exercise or sudden fright. Wolff-Parkinson-White syndrome (WPW) involves an extra electrical pathway that can, in rare cases, cause a dangerously rapid heart rhythm. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a condition in which heart muscle is gradually replaced by fatty or fibrous tissue, predisposing to arrhythmias often triggered by endurance exercise. Marfan syndrome and related connective tissue disorders can cause aortic dilatation carrying a risk of aortic dissection during intense effort. Anomalous coronary arteries, in which the arteries supplying the heart muscle follow an abnormal course, can cause compression during exercise and are usually detectable on echocardiography.
Many of these conditions produce no symptoms at all until a serious event occurs, which is precisely why screening is valuable.
A positive finding on a cardiac screen does not necessarily mean your child cannot do sport. Many children with cardiac findings participate fully in physical activity with appropriate monitoring and guidance. Dr Giardini's role is to accurately characterise the finding, assess the level of risk it carries in the context of sport, advise on which sports and intensities are safe, recommend treatment if appropriate (for example, catheter ablation for WPW, or medication for Long QT syndrome), and provide clear written documentation for schools, clubs and sporting bodies.
Some conditions, such as severe hypertrophic cardiomyopathy, do require restriction from competitive sport. Others, such as successfully treated WPW, allow full and unrestricted sporting participation after treatment. Many findings are minor and require no restriction at all. The decision is never taken lightly, and the aim is always to enable as much physical activity as safely possible, because the physical and mental health benefits of sport for children are enormous.
For children and teenagers who are actively competing, cardiac screening is not always a one-time event. Some inherited conditions, including hypertrophic cardiomyopathy and ARVC, can develop or progress during adolescence as the heart grows and changes. Repeat screening every two to three years during the teenage years is often recommended for competitive athletes. Dr Giardini will advise on the appropriate screening interval based on your child's individual risk profile and level of competition.
Dr Giardini sees children and teenagers for sport cardiology assessments at his London clinics. The full assessment, including clinical history, examination, ECG, echocardiogram and results discussion, is completed in a single visit with same-day results. Same-day, next-day and weekend appointments are available. If you would like to arrange a pre-sport cardiac screening, discuss exercise-related symptoms, or obtain individualised exercise guidance for a child with a known heart condition, please contact Dr Giardini's team to book an appointment.
There is currently no universal mandatory cardiac screening programme for young athletes in the UK. However, several sporting bodies, including Premier League football academies and some athletics programmes, have their own screening requirements. Many families choose to arrange screening independently for peace of mind.
Screening is most relevant once children begin competitive sport in earnest, which for many is around 12 years of age. However, it is appropriate at any age if there are symptoms, a family history of concern, or if a child is entering an elite sporting programme.
An ECG is an important first step, but it cannot detect all cardiac conditions. A normal ECG does not exclude structural problems such as hypertrophic cardiomyopathy in every case. An echocardiogram adds significant diagnostic value and is recommended as part of a comprehensive screen. Dr Giardini includes both as standard in every sport cardiology assessment.
In many cases, yes. Dr Giardini's expertise in exercise physiology allows him to provide specific, evidence-based guidance on which activities are safe and at what intensity. The aim is always to maximise physical activity rather than restrict it unnecessarily.
If your child experiences chest pain, palpitations, unusual breathlessness, dizziness or fainting during or after exercise, they should stop the activity and be assessed by a cardiologist before returning to sport. These symptoms are often benign, but they should not be ignored.
A comprehensive sport cardiology assessment with Dr Giardini, including history, examination, ECG, echocardiogram and results discussion, typically takes around 45 minutes. All results are available on the same day.
Yes. Dr Giardini provides a detailed written report following the assessment, which can be shared with schools, sports clubs, academies and other healthcare professionals as needed.
For competitive athletes, repeat screening every two to three years during adolescence is often recommended, as some conditions can develop or progress during growth. Dr Giardini will advise on the right interval for your child.
Yes. If your child's assessment is normal, Dr Giardini can provide formal written clearance for sporting bodies, academies and schools. If a finding is identified, he will provide detailed documentation explaining the diagnosis, risk assessment and exercise recommendations.
Author: Dr. Alessandro Giardini, MD, PhD
Written 03/04/2026