Heart & Vascular Services

Why Cardiac Screening Is a Must for Ice Hockey Athletes

December 12, 2025

Sports such as ice hockey that involve sudden, intense bursts of exertion can put significant stress on the heart and pose risks for some athletes. Cardiac screening is important before lacing up the ice skates, says Bradley Lander, MD, Director of Sports Cardiology at University Hospitals Harrington Heart & Vascular Institute.

Hockey can be higher risk for some people because of the degree of physical contact, Dr. Lander says. For example, a genetic predisposition for heart conditions such as an aortic aneurysm and dissection would pose additional risk.

“Also, if you’re on a blood thinner for atrial fibrillation or a pulmonary embolism, hockey probably is not the right sport for you. The risk of being on a blood thinner and playing a contact sport is probably too high,” Dr. Lander says.

Heart Risks

Cardiac screening is recommended for all competitive or intense athletes. The American Heart Association recommends a 14-point screening that involves taking a personal and family history and a physical exam. In addition, a cardiac evaluation could entail tests such as an electrocardiogram or a stress test in certain cases.

There are no specific cardiac screening guidelines for hockey, Dr. Lander says. He cautions that adults who are sedentary or who have risk factors like high blood pressure or high cholesterol should be especially vigilant about seeing a doctor before participating in a physically intense sport like hockey.

Research from Canada has found that middle-aged hockey players who are sedentary throughout the year and play competitive hockey once a week are at increased risk of heart attack.

Coronary artery disease is often the cause of sports-related deaths in adults, whereas non-coronary artery related sudden cardiac arrest is the leading cause of death in young athletes. Sudden cardiac arrest is often caused by an undetected heart condition such as hypertrophic cardiomyopathy, a thickened heart muscle disease. Electrical abnormalities can also disrupt the heart rhythm and cause sudden cardiac arrest.

Screening for Heart Problems

Primary care practitioners typically do cardiac screenings for sports, beginning with adolescent athletes. If there are concerns about a heart problem or family history of heart problems, athletes should be referred to a cardiologist or sports cardiologist, Dr. Lander says.

Symptoms that should be evaluated by a cardiologist include chest pain, lightheadedness, palpitations, prolonged shortness of breath, fainting or unexplained decrease in performance. Sports cardiologists evaluate and treat athletes from high schoolers to professionals and recreational athletes.

The Role of EKG

There is no routine standard for sports screening, Dr. Lander says. Typically, electrocardiogram, commonly known as EKG or ECG, is not recommended for sports screenings. But the test is being used more widely among some higher-level sports programs and otherwise should be recommended for athletes known to have certain risk factors. EKG can detect some underlying genetic conditions or heart structural defects that a routine exam would not pick up.

“The role of EKG is controversial in certain circumstances,” Dr. Lander says. “If you have easy access to a cardiologist familiar with interpreting athlete EKGs, which can be different than EKGs of the general population, then they are beneficial.”

A drawback of routine screening with EKG is interpreting results can be tricky and, in some cases, may require referral to a specialist, which can take weeks and may sideline athletes unnecessarily. “If there’s an abnormality and you have to scramble to find someone to interpret it, then athletes may have to sit out and miss playing time for a long period,” he says.

In particular, an athlete’s heart can have normal changes that may be misinterpreted. The phenomenon is called “athlete’s heart” or exercise-induced cardiac remodeling. There may be structural, electrical and functional changes to the heart that allow it to supply blood and oxygen to tissues during intense and prolonged exercise.

“The heart remodels in certain ways that can create patterns on the EKG that may look abnormal to some providers, but it’s familiar to sports cardiologists and it’s not abnormal at all,” Dr. Lander says. “Similarly, if someone has an echocardiogram or MRI that shows left ventricle or right ventricle enlargement, it may be a result of their training and physiological adaptation.”

Some heart abnormalities will disqualify people from sports competition or high-intensity exercise. But athletes, in consultation with doctors, also can safely participate with certain abnormalities or diseases.