Why is it recommended that elite athletes have both an ECG and an ECHO?

Most people that play sport are evaluated with a simple ECG and a health questionnaire. However, the very elite athletes normally undergo an ECG and an echocardiogram. To be quite honest, ECG alone is inferior to an ECG and a cardiac ultrasound. The ECG alone will exclude important electrical faults of the heart but will miss minor anatomical or structural abnormalities of the heart. Missing these abnormalities may not be so important in recreational athletes or those individuals that don’t do enough sport. But if you consider that some of our elite athletes are putting their hearts under a lot of strain, it’s possible that some of these minor structural abnormalities may become more severe with time so it’s important to pick up even the most minor problems in our most elite athletes and therefore I believe that elite athletes should have an ECG and an echocardiogram.
There is a financial argument here as well, in that most individuals that exercise in this country are not elite and if they are part of a more junior or amateur sporting organisation, the organisation may not have the funds to do an ECG – and an echocardiogram is substantially more expensive than an ECG. However, many elite organisations are funded or are financially well endowed and can afford both investigations in all their athletes.