In the shape of a Text–Atlas, this is an overview of the pathology of sudden death (SD) in the young and in the athletes, summing up the experience we gathered in the perspective study carried out in the Veneto Region, Northeast of Italy.

Like at the time of Giovanni Maria Lancisi at the beginning of 1700, when a series of victims, “who in even other respects are healthy and vigorous,” occurred in Rome thus alarming the population and the religious authorities, our interest on the topic started in the early 1980s following the autopsy of young people who died unexpectedly, either at rest or during exercise. These tragic events were touching since, as the great Leonardo da Vinci said, there is no science without feeling.

Thanks to the collaboration of forensic and anatomic pathologists of the Veneto Region, we set up a network able to cover the dissection of nearly all the cases of SD in people aged ≤35 years, with all the heart specimens and autopsy reports forwarded to the University of Padua.

It became soon evident that the majority of SD could find an explanation in hidden cardiac defects, threatening the electrical more than the mechanical properties of the heart and thus accounting for an abrupt arrhythmic “hearthquake” by ventricular fibrillation with cardiac arrest.

The singularity and novelty of the study was the availability, in many cases, of previous clinical investigations, thanks to the sport pre-participation screening including ECG that had become mandatory in Italy in 1982.

The method of clinicopathological correlation, which is at the base of our investigation following the historical tradition of Giovanni Battista Morgagni (1682–1771) at the University of Padua, allowed to detect the existence and to reconsider the value of subtle, apparently benign ECG abnormalities. Afterward, these anomalies were taken into serious attention at the pre-participation screening for further clinical investigations up to the final diagnosis and the definitive disqualification from sport activity. This experience played a fundamental role for putting forward criteria for the diagnosis of cardiomyopathies, which are the major cause of SD in the young and athletes. Mandatory screening, employment of ECG, and awareness by sport medicine doctors of the existence of hidden diseases at risk and how to diagnose them all were the key issues of the impressive results on prevention of SD, achieved simply through a “lifesaving” non-eligibility to sport activity and inherent lifestyle.