When it comes to NHL players and their hearts, little is left to chance.
Between teams' doctors and trainers, players undergo a battery of tests in the first hours of each training camp that should reveal whether there are existing cardiac problems or even potential problems.
The initial battery of tests for most teams includes a 12-lead EKG (electrocardiogram), which measures the electrical activity of the heart. If there is even a hint of a problem exposed by the EKG, then teams will then put the player (or staff member as some teams require all coaches and scouts to submit to the same tests) through a full cardio workup, including an echocardiogram or a stress echocardiogram, which gives a cross-section of the working heart and its valves, chambers and blood vessels.
In St. Louis, if a player has to undergo the secondary battery of tests, he must also meet with and be cleared by the team cardiologist, said Blues athletic trainer Ray Barile, who is also the head of the association of NHL trainers.
Chris Broadhurst, a veteran athletic therapist with the Phoenix Coyotes, said there might be a handful of tests every year that require a secondary look because they don't fit within the accepted parameters. But only once in 15 years has the echocardiogram revealed something more serious. In that case, the discovery led to open heart surgery in the fall of 2000 for Toronto Maple Leaf first-round draft pick Luca Cereda. The former Leaf prospect missed the entire 2000-01 season following the operation and now plays in the Swiss elite league. No other symptoms had been present prior to the training camp tests, Broadhurst said. Had the tests not revealed the problem, "it might have been a problem down the road," Broadhurst said.
The training camp tests don't, of course, preclude issues from coming up during the season. There are stresses and problems that may lead to situations like the one that saw Pittsburgh captain Mario Lemieux hospitalized this week.
But one by-product of the frightening situation involving Detroit defenseman Jiri Fischer that both Barile and Broadhurst have seen is that players are less likely to let chest pain or any feeling of discomfort pass as they might have been in the past.
Even if a player is traded or moves to a different league, their medical history follows them from team to team. Part of this medical information collection process is covered by a comprehensive physical evaluation form that all clubs employ. The form was designed by the association of team doctors and was approved by the players' association.
Scott Burnside is an NHL writer for ESPN.com.