Comprehensive cardiac evaluation of 156 elite para-football players revealed electrical and structural heart abnormalities in nearly half of participants over a 13-year screening period. The study documented specific ECG patterns and echocardiographic findings unique to this population, with certain abnormalities requiring sport restriction or further cardiac workup. This represents the largest systematic cardiac assessment of para-athletes to date, addressing a significant gap in sports cardiology research. The elevated abnormality rate likely reflects both the underlying medical conditions that qualify athletes for para-sport participation and potential adaptive changes from intensive training. These findings challenge current screening protocols, which were developed primarily for able-bodied athletes and may not adequately account for the complex cardiovascular profiles of para-athletes. The research suggests para-athletes may require specialized cardiac evaluation criteria, given their unique physiological baseline and the intersection of disability-related cardiovascular changes with exercise-induced adaptations. This work establishes crucial normative data for para-sport cardiology and highlights the need for tailored screening approaches that balance athlete safety with appropriate sport participation opportunities for this underserved population.