Standard electrocardiogram testing fails to detect up to 20% of cardiac conditions that cause sudden death in young athletes, according to analysis from the Indian Pacing and Electrophysiology Journal. While ECG remains the most practical screening tool for electrical heart diseases and cardiomyopathies, its diagnostic limitations become more pronounced in older athletes where coronary artery disease predominates over genetic conditions. This detection gap represents a significant challenge for sports medicine, given that most athlete fatalities occur in apparently healthy individuals with no prior symptoms. The finding reinforces that cardiovascular screening cannot rely on a single diagnostic approach, particularly as the conditions causing exercise-related sudden cardiac death span a diverse spectrum from inherited arrhythmias to structural heart defects. The research suggests that effective risk mitigation requires a multilayered strategy extending beyond initial screening. Emergency preparedness becomes equally critical, including widespread defibrillator access, rapid response protocols, and enhanced cardiac awareness education for coaches and athletes. Future screening protocols will likely integrate artificial intelligence with traditional evaluation methods to improve detection rates. For the athletic community, this analysis underscores that even comprehensive screening programs have inherent limitations, making emergency preparedness and ongoing cardiac monitoring essential components of athlete safety.