Sports cardiology as a career pathway: A fast-growing subspecialty shaping modern cardiovascular care

Cardiologists increasingly encounter competitive athletes and highly active individuals requiring nuanced cardiovascular evaluation. The intersection of intense physical activity and cardiovascular disease presents unique challenges not typically addressed in traditional training pathways. Although no dedicated certification or mandatory fellowship currently exists in the United States, the field has rapidly evolved over the past decade. Clinicians caring for athletes must be skilled in differentiating physiologic exercise-induced remodeling from pathology, managing symptomatic athletes, interpreting athlete-specific ECG and imaging findings, and leading return-to-play discussions using shared decision-making frameworks. As interest grows, the specialty has become an important component of tertiary care centers, academic programs, and multidisciplinary cardiovascular teams.

The authors outline that sports cardiology training typically begins after completion of a general cardiology fellowship. A limited number of dedicated sports cardiology fellowships exist, sometimes integrated with training in genetic cardiomyopathies. Due to the small number of programs, the authors encourage trainees to seek mentorship from sports cardiology faculty within their institutions or, when unavailable, to pursue guidance externally. Foundational resources include the American College of Cardiology’s (ACC) Sports and Exercise Cardiology Section, which provides education, research opportunities, and professional networking. The ACC’s annual meetings, including Scientific Sessions and The Care of the Athletic Heart, serve as major educational platforms. In addition, a 2017 core curriculum document outlines the essential skills required for practice, including risk assessment, guideline-based sports participation decisions, and evaluation of athletes with underlying cardiovascular abnormalities.

The article highlights multiple training and career pathways within the field. The traditional sports cardiologist is a noninvasive clinician skilled in athlete-specific cardiovascular evaluation, with particular expertise in ECG interpretation, echocardiography, and tailored exercise stress testing. The growth of multimodality cardiovascular imaging has created additional pathways, as cardiac MRI and coronary CT angiography play increasingly central roles in evaluating athletic hearts. These imaging techniques support differentiation of physiologic adaptations from pathological cardiomyopathies. Electrophysiology is another expanding pathway, driven by the prevalence of arrhythmias such as atrial fibrillation and Wolff–Parkinson–White pattern in athletes, and by the need for individualized device programming for those competing with pacemakers or defibrillators. Additional subspecialty tracks include sports interventional cardiology—particularly relevant for managing coronary artery disease in athletes—sports cardiology for congenital heart disease, and cardiology tailored to tactical athletes such as military personnel, firefighters, and law enforcement. Each pathway requires familiarity with athlete-specific physiologic demands and nuanced clinical decision-making.

The viewpoint concludes with a forward-looking perspective: embedding sports cardiology within cardiovascular care enhances both clinical care and institutional value. Athletes often require cross-collaboration across cardiology subspecialties, driving downstream referrals, imaging studies, and procedures. As the complexity of athletic cardiovascular care continues to rise, the authors call for appropriate compensation models, institutional support, and recognition of the specialty’s contribution to system-wide service delivery. They emphasize the urgent need to expand training opportunities, formally integrate sports cardiology education into fellowship curricula, and raise awareness among trainees regarding available career pathways. As the specialty continues to mature, future certification pathways are likely, making early investment in education and program development essential.

Reference: Friedman EM, Baggish AL, Chung EH, Danielian A, Dineen EH, Guseh JS, Martinez MW, Murphy CE, Shah AB, Kim JH; ACC Council on Sports and Exercise Cardiology. Sports Cardiology as a Career Pathway: Guidance for Interested Cardiovascular Trainees. JACC Adv. 2025 Oct 27;4(12 Pt 2):102305. doi: 10.1016/j.jacadv.2025.102305. Epub ahead of print. PMID: 41151251; PMCID: PMC12596595.